Provider Demographics
NPI:1477673788
Name:PATKE, JR, RAYMOND (LSCW)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:PATKE, JR
Suffix:
Gender:M
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14142 DENVER WEST PKWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3189
Mailing Address - Country:US
Mailing Address - Phone:303-237-6865
Mailing Address - Fax:303-237-6873
Practice Address - Street 1:17 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5686
Practice Address - Country:US
Practice Address - Phone:719-636-2122
Practice Address - Fax:719-636-1116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW 9925301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61579343Medicaid