MEDICARE: RYAN DIMAURO MS, LAC, LPCC, NMIT

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	101YP2500X	Professional Counselor	LPCC.0023180	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0002773	CO

General Provider Information

NPI Number	:	1770153934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DIMAURO MS, LAC, LPCC, NMIT

Provider Business Mailing Address
First Line	:	7639 SUN COUNTRY DR
Second Line	:
City	:	ELIZABETH
State	:	CO
Zip	:	80107-9383
Country	:	US
Telephone Number	:	720-480-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	7639 SUN COUNTRY DR
Second Line	:
City	:	ELIZABETH
State	:	CO
Zip	:	80107-9383
Country	:	US
Telephone Number	:	720-480-0330
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	04/10/2026

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