MEDICARE: XIOMARA GUADALUPE LEE 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	1041C0700X	Clinical Social Worker	1773	CO

General Provider Information

NPI Number	:	1124380779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIOMARA GUADALUPE LEE LCSW

Provider Business Mailing Address
First Line	:	5396 S FLANDERS WAY
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3746
Country	:	US
Telephone Number	:	303-766-8928
Fax Number	:

Provider Business Practice Location Address
First Line	:	16154 ROCK CRYSTAL DR
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-3305
Country	:	US
Telephone Number	:	303-946-5003
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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