Provider Demographics
NPI:1033511522
Name:MATRA, DANIELLE K (MSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:K
Last Name:MATRA
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 1:1300 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9584
Mailing Address - Country:US
Mailing Address - Phone:970-347-2120
Mailing Address - Fax:970-300-3127
Practice Address - Street 1:1170 W ASH ST STE 100
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4783
Practice Address - Country:US
Practice Address - Phone:970-347-2120
Practice Address - Fax:970-300-3127
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
COCSW.099251501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor