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General NPI Number Information
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NPI Number | 1972928372
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Entity Type | Individual
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Provider Name | MATTHEW LEBAUER L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2014
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Last Update Date | 02/22/2014
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Provider Practice Location Address
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Address Line | 1625 MARION ST
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City | DENVER
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State | CO
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Zip | 80218-1514
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Country | US
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Telephone | 303-830-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 LOGAN ST APT. 1608
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City | DENVER
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State | CO
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Zip | 80203-3032
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Country | US
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Telephone | 303-587-2982
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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 | CSW-1518
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License Number State | CO
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