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General NPI Number Information
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NPI Number | 1609299403
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Entity Type | Individual
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Provider Name | TINA M FANELLO L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 12605 E 16TH AVE
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City | AURORA
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State | CO
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Zip | 80045-2545
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Country | US
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Telephone | 720-848-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 406 WILHELMIA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2434
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Country | US
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Telephone | 303-859-7529
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Fax |
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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 | LCS 29167
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.00001120
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License Number State | CO
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