Healthcare Provider Details

I. General information

NPI: 1972928372
Provider Name (Legal Business Name): MATTHEW LEBAUER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2014
Last Update Date: 02/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MARION ST
DENVER CO
80218-1514
US

IV. Provider business mailing address

1055 LOGAN ST APT. 1608
DENVER CO
80203-3032
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-7337
  • Fax:
Mailing address:
  • Phone: 303-587-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1518
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: