Healthcare Provider Details

I. General information

NPI: 1528088655
Provider Name (Legal Business Name): CHERYL D MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST # 116D
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST # 116D
DENVER CO
80220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-5151
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number990840
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: