Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | CSW-992106 | CO |
NPI | 1003112178 |
---|---|
Provider Name | Holly Haman-Marcum |
First Address | Burlington, CO 80807-0726 |
Second Address | Burlington, CO 80807-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 10/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12515136 | CAQH (01) | CO |
21685835 | (05) | CO |
378165 | (02) | CO |
62673734 | (05) | CO |