Provider Demographics
NPI:1386911907
Name:CHILDREN'S MEDICAL CENTER
Entity type:Organization
Organization Name:CHILDREN'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-830-3136
Mailing Address - Street 1:1625 MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1514
Mailing Address - Country:US
Mailing Address - Phone:303-830-7337
Mailing Address - Fax:303-830-1890
Practice Address - Street 1:1625 MARION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1514
Practice Address - Country:US
Practice Address - Phone:303-830-7337
Practice Address - Fax:303-830-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-9913851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty