=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659619013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY S. PERRY, L.C.S.W., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2013
-----------------------------------------------------
Last Update Date | 01/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5808 S RAPP ST STE 100
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-430-4136
-----------------------------------------------------
Fax | 720-633-9098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5808 S RAPP ST STE 100
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-430-4136
-----------------------------------------------------
Fax | 720-633-9098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | NANCY SUSAN PERRY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 303-430-4136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 991505
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------