Provider Demographics
NPI:1144777525
Name:DIANA SHENKIN
Entity Type:Organization
Organization Name:DIANA SHENKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-250-3149
Mailing Address - Street 1:710 BURBANK ST STE F
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1658
Mailing Address - Country:US
Mailing Address - Phone:970-250-3149
Mailing Address - Fax:
Practice Address - Street 1:710 BURBANK ST STE F
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1658
Practice Address - Country:US
Practice Address - Phone:970-250-3149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.009895151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty