Provider Demographics
NPI:1477692283
Name:DEFRISCO, PAULA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:J
Last Name:DEFRISCO
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 1:1725 PEREGRINE CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1266
Mailing Address - Country:US
Mailing Address - Phone:303-587-0996
Mailing Address - Fax:303-465-1439
Practice Address - Street 1:2239 CHAMPA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2531
Practice Address - Country:US
Practice Address - Phone:303-587-0996
Practice Address - Fax:303-465-1439
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical