Healthcare Provider Details

I. General information

NPI: 1235644121
Provider Name (Legal Business Name): MAUREEN FALLON-CYR MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E 2ND AVE STE 2D
DURANGO CO
81301-5472
US

IV. Provider business mailing address

927 LEYDEN ST
DURANGO CO
81301-4953
US

V. Phone/Fax

Practice location:
  • Phone: 970-749-1691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00989988
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: