MEDICARE: JOEY LERNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	26772	CO
2	2084P0804X	Child & Adolescent Psychiatry Physician	26772	CO

General Provider Information

NPI Number	:	1083793921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEY LERNER

Provider Business Mailing Address
First Line	:	5277 MANHATTAN CIR
Second Line	:	SUITE 110
City	:	BOULDER
State	:	CO
Zip	:	80303-8201
Country	:	US
Telephone Number	:	303-543-5785
Fax Number	:	303-543-5782

Provider Business Practice Location Address
First Line	:	5277 MANHATTAN CIR
Second Line	:	SUITE 110
City	:	BOULDER
State	:	CO
Zip	:	80303-8201
Country	:	US
Telephone Number	:	303-543-5785
Fax Number	:	303-543-5782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2022

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