Provider Demographics
NPI:1457673303
Name:ANDRES, KATHRYN SEYMOUR (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:SEYMOUR
Last Name:ANDRES
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 1:18925 W 59TH PL
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1073
Mailing Address - Country:US
Mailing Address - Phone:303-856-6970
Mailing Address - Fax:
Practice Address - Street 1:6897 PAIUTE AVE STE 5
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-7169
Practice Address - Country:US
Practice Address - Phone:303-652-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09147539Medicaid