MEDICARE: DR. INDHIRA MMEFRE ANIETIE UDOFIA 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	0904012830	VA
2	1041C0700X	Clinical Social Worker	CSW.09929417	CO
3	1041C0700X	Clinical Social Worker	C0132332	NC

General Provider Information

NPI Number	:	1285117648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDHIRA MMEFRE ANIETIE UDOFIA LCSW

Provider Business Mailing Address
First Line	:	150 W 9TH AVE UNIT 1213
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4032
Country	:	US
Telephone Number	:	336-663-2819
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 W 9TH AVE UNIT 1213
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4032
Country	:	US
Telephone Number	:	336-663-2819
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	05/21/2025

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