Provider Demographics
NPI:1114365848
Name:WOLNY, MARK J (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:WOLNY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 E CHERRY CREEK SOUTH DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2283
Mailing Address - Country:US
Mailing Address - Phone:303-722-0159
Mailing Address - Fax:
Practice Address - Street 1:4900 E CHERRY CREEK SOUTH DR
Practice Address - Street 2:SUITE 5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2283
Practice Address - Country:US
Practice Address - Phone:303-722-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 102L00000X, 106H00000X
CO9894611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist