Healthcare Provider Details

I. General information

NPI: 1770153934
Provider Name (Legal Business Name): RYAN DIMAURO MS, LAC, LPCC, NMIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7639 SUN COUNTRY DR
ELIZABETH CO
80107-9383
US

IV. Provider business mailing address

7639 SUN COUNTRY DR
ELIZABETH CO
80107-9383
US

V. Phone/Fax

Practice location:
  • Phone: 720-480-0330
  • Fax:
Mailing address:
  • Phone: 720-480-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0023180
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002773
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: