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NPI Code Detail

MEDICARE: LYDIA CAMIELL GAREY PN-25642, ACC-6941

MEDICARE: LYDIA CAMIELL GAREY PN-25642, ACC-6941
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACC-6941CO
2164W00000XLicensed Practical NursePN-25642CO

General Provider Information

NPI Number : 1437456746
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA CAMIELL GAREY PN-25642, ACC-6941
Provider Business Mailing Address
First Line : 14005 E 54TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80239-4109
Country : US
Telephone Number : 303-204-3293
Fax Number :
Provider Business Practice Location Address
First Line : 1620 GAYLORD ST
Second Line :
City : DENVER
State : CO
Zip : 80206-1207
Country : US
Telephone Number : 303-388-5894
Fax Number : 303-336-1601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2011
Last Update Date : 06/04/2024

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