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General NPI Number Information
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NPI Number | 1568353944
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Entity Type | Individual
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Provider Name | ALECXANDR PATRICK SUGRUE MSW
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 4856 INNOVATION DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-5539
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Country | US
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Telephone | 970-494-4200
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Fax | 844-270-1824
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Provider Business Mailing Address
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Address Line | 4856 INNOVATION DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-5539
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Country | US
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Telephone | 970-494-4200
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Fax | 844-270-1824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW.0009926465
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License Number State | CO
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