Healthcare Provider Details

I. General information

NPI: 1730276452
Provider Name (Legal Business Name): JOLI NICOL PATE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOLI NICOL PATE LCSW

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 WALNUT ST
BOULDER CO
80302-5032
US

IV. Provider business mailing address

900 CRESCENT DR
BOULDER CO
80303-2717
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-8846
  • Fax:
Mailing address:
  • Phone: 505-819-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1175
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05236
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0243
License Number StateNM

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: