Healthcare Provider Details

I. General information

NPI: 1609449529
Provider Name (Legal Business Name): AMY MARYAM NAVVAB LSCW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W BAYAUD AVE
DENVER CO
80219-2105
US

IV. Provider business mailing address

2737 W BAYAUD AVE
DENVER CO
80219-2105
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-2132
  • Fax:
Mailing address:
  • Phone: 734-276-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number323003
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09927410
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: