Healthcare Provider Details

I. General information

NPI: 1598119281
Provider Name (Legal Business Name): MEGAN CRONIN LARSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN JANE CRONIN

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S. BROADWAY STREET
BOULDER CO
80304
US

IV. Provider business mailing address

304 S. CEDAR BROOK RD.
BOULDER CO
80304
US

V. Phone/Fax

Practice location:
  • Phone: 720-822-0141
  • Fax:
Mailing address:
  • Phone: 720-822-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923827
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: