Provider Demographics
NPI:1619593316
Name:MALCOLM, RICHARD H (MSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:MALCOLM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2625
Mailing Address - Country:US
Mailing Address - Phone:970-238-0568
Mailing Address - Fax:
Practice Address - Street 1:1416 LARIMER ST STE 207
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1788
Practice Address - Country:US
Practice Address - Phone:970-238-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099224461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical