Healthcare Provider Details

I. General information

NPI: 1982756870
Provider Name (Legal Business Name): MARIANNE SCHRAM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 IRIS AVE
BOULDER CO
80304-2226
US

IV. Provider business mailing address

561 BRAINARD CIR
LAFAYETTE CO
80026-3407
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax: 303-661-0818
Mailing address:
  • Phone: 720-562-0526
  • Fax: 303-661-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number984033
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: