Healthcare Provider Details

I. General information

NPI: 1992046908
Provider Name (Legal Business Name): MARLA M MADRID MSW, LCSW, LAC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 01/22/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 S 1ST ST
BENNETT CO
80102-7860
US

IV. Provider business mailing address

190 S 1ST ST
BENNETT CO
80102-7860
US

V. Phone/Fax

Practice location:
  • Phone: 303-644-4240
  • Fax: 303-644-4250
Mailing address:
  • Phone: 303-644-4240
  • Fax: 303-644-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD0000719
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW00001915
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT0001999
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: