Provider Demographics
NPI:1235565250
Name:VANDERWERFF, JAY (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:VANDERWERFF
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2612
Mailing Address - Country:US
Mailing Address - Phone:970-498-7493
Mailing Address - Fax:
Practice Address - Street 1:2555 MIDPOINT DR
Practice Address - Street 2:SUITE A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4425
Practice Address - Country:US
Practice Address - Phone:970-498-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099247761041C0700X
COACD.0000765101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)