Provider Demographics
NPI:1588997514
Name:ANGELO, GEORGIA SHEPARD
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:SHEPARD
Last Name:ANGELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 S COLORADO BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5945
Mailing Address - Country:US
Mailing Address - Phone:303-639-5240
Mailing Address - Fax:303-639-5243
Practice Address - Street 1:2696 S COLORADO BLVD
Practice Address - Street 2:SUITE 380
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5945
Practice Address - Country:US
Practice Address - Phone:303-639-5240
Practice Address - Fax:303-639-5243
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099243781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical