Healthcare Provider Details

I. General information

NPI: 1154581908
Provider Name (Legal Business Name): JENNIFER A WORCESTER LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19557 E MAINSTREET # 200
PARKER CO
80138-7420
US

IV. Provider business mailing address

19563 E MAINSTREET STE 200
PARKER CO
80138-7394
US

V. Phone/Fax

Practice location:
  • Phone: 303-475-2323
  • Fax:
Mailing address:
  • Phone: 303-475-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005698
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: