MEDICARE: MATTHEW WARREN LAROCK MSW, LSW, CACII

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.0009921950	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001121	CO

General Provider Information

NPI Number	:	1174949192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WARREN LAROCK MSW, LSW, CACII

Provider Business Mailing Address
First Line	:	PO BOX 883438
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80488-3438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PARK AVE STE 204
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-846-6379
Fax Number	:

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

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	09/14/2023

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