Healthcare Provider Details

I. General information

NPI: 1609078534
Provider Name (Legal Business Name): CASSANDRA RENEE MATZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA RENEE GRELLA BA

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR SUITE 200
AURORA CO
80014-2622
US

IV. Provider business mailing address

11059 E BETHANY DR SUITE 200
AURORA CO
80014-2622
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-2606
  • Fax: 303-617-2475
Mailing address:
  • Phone: 303-617-2606
  • Fax: 303-617-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923532
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: