Provider Demographics
NPI:1376046292
Name:MCCARRON, LONNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:MCCARRON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 OAK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1429
Mailing Address - Country:US
Mailing Address - Phone:719-264-8150
Mailing Address - Fax:
Practice Address - Street 1:600 EVANS RD
Practice Address - Street 2:FREMONT CORRECTIONAL FACILITY
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-269-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099252401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical