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NPI Code Detail

MEDICARE: MADISON NOLA LSW

MEDICARE: MADISON NOLA 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
11041C0700XClinical Social WorkerLSW.0009925317CO

General Provider Information

NPI Number : 1891495107
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON NOLA LSW
Provider Business Mailing Address
First Line : 4067 CLEAR CREEK DR
Second Line :
City : GOLDEN
State : CO
Zip : 80401-2182
Country : US
Telephone Number : 716-994-3069
Fax Number :
Provider Business Practice Location Address
First Line : 2921 W 120TH AVE UNIT 100
Second Line :
City : WESTMINSTER
State : CO
Zip : 80234-2944
Country : US
Telephone Number : 888-528-3680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2023
Last Update Date : 10/08/2024

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Directions to “ MADISON NOLA LSW” Practice Location

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