MEDICARE: DREAMAGIK, 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	103T00000X	Psychologist	2441	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001646464	OTHER	CO	ANTHEM

General Provider Information

NPI Number	:	1477738920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAMAGIK, PC

Provider Business Mailing Address
First Line	:	1271 LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2315
Country	:	US
Telephone Number	:	303-394-3928
Fax Number	:	303-394-4933

Provider Business Practice Location Address
First Line	:	1271 LAFAYETTE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2315
Country	:	US
Telephone Number	:	303-394-3928
Fax Number	:	303-394-4933

Authorized Official
Title or Position	:	PSYCHOLOGIST/DIRECTOR
Name	:	DR. KATHY MARTONE
Credential	:	ED.D.
Telephone Number	:	303-394-3928

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	05/09/2008

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