Provider Demographics
NPI:1215227665
Name:CHAVEZ, DARLENE JOSETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:JOSETTE
Last Name:CHAVEZ
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 1:3608 GALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4310
Mailing Address - Country:US
Mailing Address - Phone:855-384-2656
Mailing Address - Fax:888-389-8263
Practice Address - Street 1:1360 S WADSWORTH BLVD
Practice Address - Street 2:STE 112
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5415
Practice Address - Country:US
Practice Address - Phone:855-384-2656
Practice Address - Fax:888-389-8263
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9893961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55478557Medicaid
CO356271ZGF9OtherMEDICARE PTAN
CO356271ZGF9Medicare PIN