MEDICARE: BETH BARTA LCSW CAC 111 LLC

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	992831	CO

General Provider Information

NPI Number	:	1427464932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH BARTA LCSW CAC 111 LLC

Provider Business Mailing Address
First Line	:	PO BOX 181884
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-8835
Country	:	US
Telephone Number	:	303-246-3219
Fax Number	:	720-386-9758

Provider Business Practice Location Address
First Line	:	1750 N LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1117
Country	:	US
Telephone Number	:	209-266-7667
Fax Number	:	720-386-9758

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANY ANN BARTA
Credential	:
Telephone Number	:	720-926-6766

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	11/05/2024

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