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NPI Code Detail

MEDICARE: ZACHARY PETERSON MSW,LCSW

MEDICARE: ZACHARY PETERSON MSW,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
1104100000XSocial Worker
21041C0700XClinical Social WorkerCSW.09929242CO

General Provider Information

NPI Number : 1497396279
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY PETERSON MSW,LCSW
Provider Business Mailing Address
First Line : 1455 E 3RD AVE
Second Line :
City : LONGMONT
State : CO
Zip : 80501-8702
Country : US
Telephone Number : 601-988-2418
Fax Number :
Provider Business Practice Location Address
First Line : 2305 E ARAPAHOE RD STE 240
Second Line :
City : CENTENNIAL
State : CO
Zip : 80122-1565
Country : US
Telephone Number : 720-706-2957
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2019
Last Update Date : 09/12/2024

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