MEDICARE: STEFANIE RACCUGLIA PC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1275192213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEFANIE RACCUGLIA PC

Provider Business Mailing Address
First Line	:	191 UNIVERSITY BLVD # 646
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-4613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 W 32ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3373
Country	:	US
Telephone Number	:	720-626-0274
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEFANIE RACCUGLIA
Credential	:	LPC, R-DMT
Telephone Number	:	720-626-0274

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

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