Provider Demographics
NPI:1518102169
Name:PACHECO, DENICE LORRAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENICE
Middle Name:LORRAINE
Last Name:PACHECO
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 1:1920 W 5200 S
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3452
Mailing Address - Country:US
Mailing Address - Phone:801-628-1762
Mailing Address - Fax:801-776-3892
Practice Address - Street 1:5748 S 2200 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1502
Practice Address - Country:US
Practice Address - Phone:801-628-1762
Practice Address - Fax:801-776-3892
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373799-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical