=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407719800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE ROSE GORMAN MSW, SWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 MIDLAND AVE
-----------------------------------------------------
City | BASALT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81621-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-925-5858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1115
-----------------------------------------------------
City | BASALT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81621-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-924-0703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SWC.0000000908
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------