Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY.0004779 | CO |
Y | 103TC0700X | Clinical Psychologist | PSY.0004779 | CO |
N | 102L00000X | Psychologist | PSY.0004779 | CO |
N | 103T00000X | Psychologist | PSY.0004779 | CO |
N | 103TR0400X | Rehabilitation Psychologist | PSY.0004779 | CO |
NPI | 1578050084 |
---|---|
Provider Name | Dr. Jason Alan Kacmarski |
First Address | Denver, CO 80246-0266 |
Second Address | Aurora, CO 80045-7211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 21/06/2021 |