MEDICARE: DR. NOELLE L LEFFORGE PH.D.

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	PSY.0005500	CO
2	103TC0700X	Clinical Psychologist	PY0648	NV
3	103TC0700X	Clinical Psychologist	PSY.0005500	CO
4	103TP2701X	Group Psychotherapy Psychologist	PY0648	NV
5	103TP2701X	Group Psychotherapy Psychologist	PSY.0005500	CO
6	103T00000X	Psychologist	PY0648	NV

General Provider Information

NPI Number	:	1538422563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOELLE L LEFFORGE PH.D.

Provider Business Mailing Address
First Line	:	2450 S VINE ST
Second Line	:	RM 43
City	:	DENVER
State	:	CO
Zip	:	80210-5264
Country	:	US
Telephone Number	:	702-757-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 S VINE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5264
Country	:	US
Telephone Number	:	702-757-8601
Fax Number	:

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	07/12/2021

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