Provider Demographics
NPI:1346954781
Name:PARTRIDGE, CARLY (MA)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:PARTRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:250 VINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4653
Mailing Address - Country:US
Mailing Address - Phone:920-915-8001
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST STE 504
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5414
Practice Address - Country:US
Practice Address - Phone:920-915-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC0018338101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor