Provider Demographics
NPI:1528186202
Name:LALIBERTE, NICHOLE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:MARIE
Last Name:LALIBERTE
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:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-1806
Mailing Address - Country:US
Mailing Address - Phone:303-525-8331
Mailing Address - Fax:
Practice Address - Street 1:420 S HOWES ST
Practice Address - Street 2:STE B-100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2871
Practice Address - Country:US
Practice Address - Phone:303-525-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39909344Medicaid