Provider Demographics
NPI:1073666491
Name:PARKER, KATHERINE MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2347
Mailing Address - Country:US
Mailing Address - Phone:303-499-1121
Mailing Address - Fax:303-499-9332
Practice Address - Street 1:3100 BUCKNELL CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3465
Practice Address - Country:US
Practice Address - Phone:303-499-1121
Practice Address - Fax:303-499-9332
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical