Healthcare Provider Details

I. General information

NPI: 1205111960
Provider Name (Legal Business Name): MARIAH CECELIA HOFMEISTER LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH BEAMAN

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CENTRE AVE
FORT COLLINS CO
80526-2023
US

IV. Provider business mailing address

4856 INNOVATION DR STE B
FORT COLLINS CO
80525-5540
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax:
Mailing address:
  • Phone: 970-494-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923839
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: