MEDICARE: JULIA CARLSON LANDY LCSW

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	104100000X	Social Worker	LSW.9921673	CO
2	1041C0700X	Clinical Social Worker	CSW.09926347	CO

General Provider Information

NPI Number	:	1104338524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CARLSON LANDY LCSW

Provider Business Mailing Address
First Line	:	1325 S COLORADO BLVD STE 410
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3341
Country	:	US
Telephone Number	:	303-219-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE 410
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3341
Country	:	US
Telephone Number	:	720-282-9557
Fax Number	:

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	11/29/2022

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