Provider Demographics
NPI:1205012531
Name:MADRID, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MADRID
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 1:9360 LOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3103
Mailing Address - Country:US
Mailing Address - Phone:720-205-1462
Mailing Address - Fax:
Practice Address - Street 1:56541 E. COLFAX
Practice Address - Street 2:B
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136
Practice Address - Country:US
Practice Address - Phone:720-205-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW 9871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1205012531Medicaid