Healthcare Provider Details

I. General information

NPI: 1770782336
Provider Name (Legal Business Name): BARRY ERDMAN AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 PENROSE PL SUITE 210
BOULDER CO
80301-1828
US

IV. Provider business mailing address

3450 PENROSE PL SUITE 210
BOULDER CO
80301-1828
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-1404
  • Fax: 303-444-3491
Mailing address:
  • Phone: 303-444-1404
  • Fax: 303-444-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989018
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. BARRY ERDMAN
Title or Position: PRESIDENT
Credential: LCSW, DCSW
Phone: 303-444-1404