Healthcare Provider Details

I. General information

NPI: 1477738920
Provider Name (Legal Business Name): DREAMAGIK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 LAFAYETTE ST
DENVER CO
80218-2315
US

IV. Provider business mailing address

1271 LAFAYETTE ST
DENVER CO
80218-2315
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-3928
  • Fax: 303-394-4933
Mailing address:
  • Phone: 303-394-3928
  • Fax: 303-394-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2441
License Number StateCO

VIII. Authorized Official

Name: DR. KATHY MARTONE
Title or Position: PSYCHOLOGIST/DIRECTOR
Credential: ED.D.
Phone: 303-394-3928