Provider Demographics
NPI:1326162397
Name:TASHIRO, NANCY R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:TASHIRO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST.
Mailing Address - Street 2:#403
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7404
Mailing Address - Country:US
Mailing Address - Phone:303-772-7752
Mailing Address - Fax:303-772-1771
Practice Address - Street 1:1707 MAIN ST.
Practice Address - Street 2:#403
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7404
Practice Address - Country:US
Practice Address - Phone:303-772-7752
Practice Address - Fax:303-772-1771
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist