Provider Demographics
NPI:1164145462
Name:VIEZCA, EDUARDO (LSW)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:VIEZCA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 W NEVADA PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2019
Mailing Address - Country:US
Mailing Address - Phone:720-445-5858
Mailing Address - Fax:
Practice Address - Street 1:789 N SHERMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3529
Practice Address - Country:US
Practice Address - Phone:720-445-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.00099240151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical