Healthcare Provider Details

I. General information

NPI: 1558492462
Provider Name (Legal Business Name): STARLENE S PELUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STARLENE S MARKWALDER

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

4851 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6715
US

V. Phone/Fax

Practice location:
  • Phone: 310-403-8766
  • Fax:
Mailing address:
  • Phone: 303-425-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF48666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0001623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: