Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 9923835 | CO |
NPI | 1003151754 |
---|---|
Provider Name | Ilene Nicole Solomon |
First Address | Denver, CO 80204-2211 |
Second Address | Denver, CO 80204-2211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 20/01/2015 |