Healthcare Provider Details

I. General information

NPI: 1780303768
Provider Name (Legal Business Name): DANA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 PENROSE PL STE 210
BOULDER CO
80301-1874
US

IV. Provider business mailing address

1500 N GRANT ST # 4419
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 720-558-3174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930608
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: