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NPI Code Detail

MEDICARE: OLIVIA BRAY MENESES MSW, LSW

MEDICARE:   OLIVIA BRAY MENESES  MSW, 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
1104100000XSocial WorkerLSW.0009924069CO

General Provider Information

NPI Number : 1912614504
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA BRAY MENESES MSW, LSW
Provider Business Mailing Address
First Line : 1507 RIVERSIDE AVE UNIT 200
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4383
Country : US
Telephone Number : 970-658-0561
Fax Number :
Provider Business Practice Location Address
First Line : 1507 RIVERSIDE AVE UNIT 200
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4383
Country : US
Telephone Number : 970-658-0561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2022
Last Update Date : 11/02/2022

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Directions to “ OLIVIA BRAY MENESES MSW, LSW” Practice Location

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