Healthcare Provider Details

I. General information

NPI: 1386911907
Provider Name (Legal Business Name): CHILDREN'S MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MARION ST
DENVER CO
80218-1514
US

IV. Provider business mailing address

1625 MARION ST
DENVER CO
80218-1514
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-7337
  • Fax: 303-830-1890
Mailing address:
  • Phone: 303-830-7337
  • Fax: 303-830-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-991385
License Number StateCO

VIII. Authorized Official

Name: MS. KRISTEN K ROY
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 303-830-3136