1457323818 NPI number — MR. LARRY WARREN FISHER MSW, LCSW

Table of content: MR. LARRY WARREN FISHER MSW, LCSW (NPI 1457323818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457323818 NPI number — MR. LARRY WARREN FISHER MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
LARRY
Provider Middle Name:
WARREN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

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:
1457323818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6327
Provider Second Line Business Mailing Address:
VA OUTPATIENT CLINIC
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80045-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-724-0217
Provider Business Mailing Address Fax Number:
303-724-0828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13001 E 17TH PL
Provider Second Line Business Practice Location Address:
VA OUTPATIENT CLINIC
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80010-7238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-724-0217
Provider Business Practice Location Address Fax Number:
303-724-0828
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  991758 , 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)





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