Provider Demographics
NPI:1063423283
Name:KAVANAH
Entity type:Organization
Organization Name:KAVANAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OVERSEER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FRIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OVS MD
Authorized Official - Phone:303-355-7783
Mailing Address - Street 1:KAVANAH C/O NON-DOMESTIC
Mailing Address - Street 2:820 S MONACO PKWY, #293
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224
Mailing Address - Country:US
Mailing Address - Phone:303-355-7783
Mailing Address - Fax:303-355-7784
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 309
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-355-7783
Practice Address - Fax:303-355-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO290052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty