MEDICARE: AVERI LYN SCHAUBMAN 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	986068	CO

General Provider Information

NPI Number	:	1194873265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERI LYN SCHAUBMAN LCSW

Provider Business Mailing Address
First Line	:	2840 XANTHIA COURT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2655
Country	:	US
Telephone Number	:	303-906-2472
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 E ILIFF AVENUE
Second Line	:	SUITE 105
City	:	DENVER
State	:	CO
Zip	:	80222-6049
Country	:	US
Telephone Number	:	303-906-2472
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/27/2012

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