Healthcare Provider Details

I. General information

NPI: 1962063404
Provider Name (Legal Business Name): ABBIE ROSEMARY PENNETTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBIE ROSEMARY BARSE LCSW

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 AURORA CT STE &5200
AURORA CO
80045-2541
US

IV. Provider business mailing address

12401 E 17TH AVE
AURORA CO
80045-2548
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-2080
  • Fax:
Mailing address:
  • Phone: 207-848-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925942
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: