Provider Demographics
NPI:1083899116
Name:PONCE, NIDIA A (MSW)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:A
Last Name:PONCE
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 1:3758 E 104TH AVE # 608
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4434
Mailing Address - Country:US
Mailing Address - Phone:303-500-9894
Mailing Address - Fax:
Practice Address - Street 1:9525 E. 112TH DRIVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:CO
Practice Address - Zip Code:80640
Practice Address - Country:US
Practice Address - Phone:303-500-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical