Provider Demographics
NPI:1659478295
Name:LALIBERTE, DENISE MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARIE
Last Name:LALIBERTE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 N TEJON ST
Mailing Address - Street 2:SUITE 303E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1534
Mailing Address - Country:US
Mailing Address - Phone:719-475-0877
Mailing Address - Fax:719-475-7615
Practice Address - Street 1:19 N TEJON ST
Practice Address - Street 2:SUITE 303E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1534
Practice Address - Country:US
Practice Address - Phone:719-475-0877
Practice Address - Fax:719-475-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9916391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO138531Medicaid