Provider Demographics
NPI:1467577932
Name:QUARLES, VICKI L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:L
Last Name:QUARLES
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4770
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:1755 48TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2711
Practice Address - Country:US
Practice Address - Phone:303-494-5263
Practice Address - Fax:303-494-5265
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COCSW.000006721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11221569Medicaid
COC808654Medicare PIN
CO11221569Medicaid