MEDICARE: ELLEN PERRICONE MSW, LSW

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	104100000X	Social Worker	9630137	CO

General Provider Information

NPI Number	:	1750681136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN PERRICONE MSW, LSW

Provider Business Mailing Address
First Line	:	2796 UTICA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-3046
Country	:	US
Telephone Number	:	720-810-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2796 UTICA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-3046
Country	:	US
Telephone Number	:	720-810-4740
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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