Healthcare Provider Details

I. General information

NPI: 1427931567
Provider Name (Legal Business Name): MARY ELIZABETH WHALEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30044 ROAN DR
EVERGREEN CO
80439-8643
US

IV. Provider business mailing address

750 W HAMPDEN AVE STE 415
ENGLEWOOD CO
80110-2151
US

V. Phone/Fax

Practice location:
  • Phone: 914-582-6070
  • Fax:
Mailing address:
  • Phone: 720-377-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931115
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: