Provider Demographics
NPI:1639202526
Name:ALTMAN, STEPHANIE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:ALTMAN
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 1:8745 W 14TH AVE
Mailing Address - Street 2:SUITE 216-D
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4889
Mailing Address - Country:US
Mailing Address - Phone:303-233-1778
Mailing Address - Fax:
Practice Address - Street 1:8745 W 14TH AVE
Practice Address - Street 2:SUITE 216-D
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4889
Practice Address - Country:US
Practice Address - Phone:303-233-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9921961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70305862Medicaid