Healthcare Provider Details

I. General information

NPI: 1760624415
Provider Name (Legal Business Name): AMI GORSKY-ZABUKOVIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W 15TH ST STE 200
PUEBLO CO
81003-2716
US

IV. Provider business mailing address

3676 PARKER BLVD STE 350
PUEBLO CO
81008-2213
US

V. Phone/Fax

Practice location:
  • Phone: 719-296-6000
  • Fax: 719-545-1146
Mailing address:
  • Phone: 719-296-6000
  • Fax: 719-545-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09925196
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: