Provider Demographics
NPI:1194307538
Name:BRISSETTE, AMY RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENEE
Last Name:BRISSETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENEE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8003 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 S. COLORADO BLVD
Practice Address - Street 2:TOWER 1, STE 2000-4
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7900
Practice Address - Country:US
Practice Address - Phone:303-884-9682
Practice Address - Fax:303-474-6521
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099268961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000171712Medicaid