Healthcare Provider Details

I. General information

NPI: 1407379092
Provider Name (Legal Business Name): TODD C. OGNIBENE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 YORK STREET, THIRD FLOOR
DENVER CO
80206
US

IV. Provider business mailing address

PO BOX 270587
LITTLETON CO
80127-0010
US

V. Phone/Fax

Practice location:
  • Phone: 303-550-7832
  • Fax:
Mailing address:
  • Phone: 303-917-0689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0004610
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: