Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 989953 | CO |
NPI | 1003257973 |
---|---|
Provider Name | Ms. Cindy J Smith |
First Address | Boulder, CO 80302-4809 |
Second Address | Boulder, CO 80302-4809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 08/07/2013 |