Provider Demographics
NPI:1275372591
Name:PETERSON, CYNTHIA LUDLOW (LSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LUDLOW
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1576
Mailing Address - Country:US
Mailing Address - Phone:303-880-0068
Mailing Address - Fax:
Practice Address - Street 1:789 N SHERMAN ST STE 580
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3523
Practice Address - Country:US
Practice Address - Phone:720-463-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099303321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical