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NPI Code Detail

MEDICARE: JASON DEABUENO MSW, LCSW

MEDICARE:   JASON  DEABUENO  MSW, 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
11041C0700XClinical Social Worker992616CO

General Provider Information

NPI Number : 1114143955
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON DEABUENO MSW, LCSW
Provider Business Mailing Address
First Line : 1570 PROMONTORY BLUFF VW
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3949
Country : US
Telephone Number : 719-572-6100
Fax Number :
Provider Business Practice Location Address
First Line : 1625 S MURRAY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-4502
Country : US
Telephone Number : 719-884-2310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 06/10/2019

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