Provider Demographics
NPI:1275744096
Name:ARMIJO, ADELINE DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:DEBORAH
Last Name:ARMIJO
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 1:7 ENCINO PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2948
Mailing Address - Country:US
Mailing Address - Phone:719-561-9084
Mailing Address - Fax:719-564-5605
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:STE 326
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3130
Practice Address - Country:US
Practice Address - Phone:480-209-8137
Practice Address - Fax:719-564-5605
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9899791041C0700X
CO52649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD0336Medicare ID - Type Unspecified