Provider Demographics
NPI:1376804211
Name:COMPONO, SHARON KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:COMPONO
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 1:7665 ASSISI HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3837
Mailing Address - Country:US
Mailing Address - Phone:719-955-7009
Mailing Address - Fax:719-598-0346
Practice Address - Street 1:7665 ASSISI HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3837
Practice Address - Country:US
Practice Address - Phone:719-955-7009
Practice Address - Fax:719-598-0346
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-21271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical