=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861613234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN JOSHUA RABE B.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 SAGE PL
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80537-9152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-853-3556
-----------------------------------------------------
Fax | 303-426-9384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 SAGE PL
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80537-9152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-853-3556
-----------------------------------------------------
Fax | 303-426-9384
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------