Provider Demographics
NPI:1982756870
Name:SCHRAM, MARIANNE (MSW)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:SCHRAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BRAINARD CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3407
Mailing Address - Country:US
Mailing Address - Phone:720-562-0526
Mailing Address - Fax:303-661-0818
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:303-661-0818
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9840331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COR81896Medicare UPIN
C23359Medicare ID - Type Unspecified