Healthcare Provider Details

I. General information

NPI: 1720382526
Provider Name (Legal Business Name): MILES DANIEL KRAMER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 OAK SHADOW WAY
FORT COLLINS CO
80528-6909
US

IV. Provider business mailing address

4027 OAK SHADOW WAY
FORT COLLINS CO
80528-6909
US

V. Phone/Fax

Practice location:
  • Phone: 970-397-7683
  • Fax:
Mailing address:
  • Phone: 970-397-7683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19941
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1744
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: