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General NPI Number Information
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NPI Number | 1609104991
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Entity Type | Individual
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Provider Name | CARMEN LOUISE SAMPLE MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 606 MOUNTAIN VIEW AVE
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City | LONGMONT
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State | CO
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Zip | 80501-2779
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Country | US
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Telephone | 303-523-8057
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Fax | 303-772-0629
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Provider Business Mailing Address
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Address Line | 606 MOUNTAIN VIEW AVE
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City | LONGMONT
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State | CO
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Zip | 80501-2779
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Country | US
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Telephone | 303-523-8057
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Fax | 303-772-0629
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1736
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 249
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License Number State | CO
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