Provider Demographics
NPI:1609500776
Name:DESHMUKH, MADHURI SUBHASHRAO
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:SUBHASHRAO
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6020
Mailing Address - Country:US
Mailing Address - Phone:484-655-5499
Mailing Address - Fax:
Practice Address - Street 1:430 NEWPORT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6020
Practice Address - Country:US
Practice Address - Phone:484-655-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health