Healthcare Provider Details

I. General information

NPI: 1710199823
Provider Name (Legal Business Name): NATALIE KICK RIES CICOTELLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE RIES

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

13087 RACE CT
THORNTON CO
80241-4118
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4044
  • Fax:
Mailing address:
  • Phone: 720-929-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1552
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: