Healthcare Provider Details

I. General information

NPI: 1982857645
Provider Name (Legal Business Name): CHARISSA MARIA CZARNIAWSKI IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 10/30/2025
Reactivation Date: 12/15/2025

III. Provider practice location address

80 CHILDE DR
COLORADO SPRINGS CO
80906-4354
US

IV. Provider business mailing address

80 CHILDE DR
COLORADO SPRINGS CO
80906-4354
US

V. Phone/Fax

Practice location:
  • Phone: 619-252-9786
  • Fax:
Mailing address:
  • Phone: 760-725-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009926371
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: