Healthcare Provider Details

I. General information

NPI: 1851872527
Provider Name (Legal Business Name): RENEE MICHELLE MARTINEZ-EPPERSON MSW, LCSW, CAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12106 RIO SECCO RD
PEYTON CO
80831-4032
US

IV. Provider business mailing address

12106 RIO SECCO RD
PEYTON CO
80831-4032
US

V. Phone/Fax

Practice location:
  • Phone: 719-963-8772
  • Fax:
Mailing address:
  • Phone: 719-963-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09923654
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: