Provider Demographics
NPI:1104836378
Name:PEDERSON, ADRIENNE L (LCSW)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:L
Last Name:PEDERSON
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 1:7095 BRAUN CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1142
Mailing Address - Country:US
Mailing Address - Phone:303-898-4348
Mailing Address - Fax:
Practice Address - Street 1:3955 STEELE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3613
Practice Address - Country:US
Practice Address - Phone:720-424-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical