Provider Demographics
NPI:1124379359
Name:GROSSO- BURKE, ANGELA MAY (MSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAY
Last Name:GROSSO- BURKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MAY
Other - Last Name:GROSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1334 S WELDONA LN
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1640 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1216
Practice Address - Country:US
Practice Address - Phone:720-755-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099237561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical