MEDICARE: JONI MICHELLE HANDRAN LCSW, CAC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6431	CO
2	104100000X	Social Worker	835	CO

General Provider Information

NPI Number	:	1861702722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI MICHELLE HANDRAN LCSW, CAC III

Provider Business Mailing Address
First Line	:	3165 N SPEER BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3764
Country	:	US
Telephone Number	:	720-261-7042
Fax Number	:	866-271-5038

Provider Business Practice Location Address
First Line	:	2150 W 29TH AVE
Second Line	:	SUITE 330
City	:	DENVER
State	:	CO
Zip	:	80211-3844
Country	:	US
Telephone Number	:	720-261-7042
Fax Number	:	866-271-5038

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	11/01/2013

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