Healthcare Provider Details

I. General information

NPI: 1033876719
Provider Name (Legal Business Name): MARIA BOERO-LEGGE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA BOERO PHD

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 303-602-0002
  • Fax: 303-602-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number00014300
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: