Provider Demographics
NPI:1497726111
Name:DENMARK, RAINA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAINA
Middle Name:M
Last Name:DENMARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S COLLEGE AVE
Mailing Address - Street 2:STE.200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3184
Mailing Address - Country:US
Mailing Address - Phone:970-495-6564
Mailing Address - Fax:970-482-7300
Practice Address - Street 1:112 S COLLEGE AVE
Practice Address - Street 2:STE.200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3184
Practice Address - Country:US
Practice Address - Phone:970-495-6564
Practice Address - Fax:970-482-7300
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1618103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist