MEDICARE: INSTITUTE FOR ATTACHMENT & CHILD DEVELOPMENT, INC.

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	1041C0700X	Clinical Social Worker	992444	CO

General Provider Information

NPI Number	:	1871795963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR ATTACHMENT & CHILD DEVELOPMENT, INC.

Provider Business Mailing Address
First Line	:	5921 MIDDLEFIELD RD STE 201
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2860
Country	:	US
Telephone Number	:	303-674-1910
Fax Number	:	303-670-3983

Provider Business Practice Location Address
First Line	:	5921 MIDDLEFIELD RD STE 201
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2860
Country	:	US
Telephone Number	:	303-674-1910
Fax Number	:	303-670-3983

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. FORREST LIEN
Credential	:	LCSW
Telephone Number	:	303-674-1910

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	04/19/2016

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