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NPI Code Detail

MEDICARE: JACOB WATANABE LCSW

MEDICARE: JACOB WATANABE 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.09928893CO

General Provider Information

NPI Number : 1801530696
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB WATANABE LCSW
Provider Business Mailing Address
First Line : 700 POTOMAC ST
Second Line :
City : AURORA
State : CO
Zip : 80011-6844
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1325 S COLORADO BLVD STE B705
Second Line :
City : DENVER
State : CO
Zip : 80222-3383
Country : US
Telephone Number : 888-528-3860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2022
Last Update Date : 01/05/2023

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Directions to “ JACOB WATANABE LCSW” Practice Location

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