Provider Demographics
NPI:1972928372
Name:LEBAUER, MATTHEW (LCSW)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:LEBAUER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 LOGAN ST
Mailing Address - Street 2:APT. 1608
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3032
Mailing Address - Country:US
Mailing Address - Phone:303-587-2982
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-15181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical