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NPI Code Detail

MEDICARE: MARNESSA J BAMBARA LCSW

MEDICARE: MARNESSA J BAMBARA 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
1104100000XSocial Worker087302NY
2104100000XSocial Worker09926336CO

General Provider Information

NPI Number : 1154715894
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARNESSA J BAMBARA LCSW
Provider Business Mailing Address
First Line : 4770 BASELINE RD STE 200
Second Line :
City : BOULDER
State : CO
Zip : 80303-2668
Country : US
Telephone Number : 720-893-0842
Fax Number : 617-507-1426
Provider Business Practice Location Address
First Line : 4770 BASELINE RD STE 200
Second Line :
City : BOULDER
State : CO
Zip : 80303-2668
Country : US
Telephone Number : 720-893-0842
Fax Number : 617-507-1426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2015
Last Update Date : 04/13/2020

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Directions to “ MARNESSA J BAMBARA LCSW” Practice Location

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