1205335049 NPI number — DANIELLE PETERS LCSW LLC

Table of content: (NPI 1205335049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205335049 NPI number — DANIELLE PETERS LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIELLE PETERS LCSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205335049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9324 E 58TH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80238-2370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-807-2851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9324 E 58TH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80238-2370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-807-2851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
571-643-6170

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW.09924446 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1801200084 . This is a "CIGNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1801200084 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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