Provider Demographics
NPI:1659544401
Name:DISORBIO, JOHN MARK (EDD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:DISORBIO
Suffix:
Gender:M
Credentials:EDD
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 2950
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-2950
Mailing Address - Country:US
Mailing Address - Phone:303-674-7171
Mailing Address - Fax:303-674-1223
Practice Address - Street 1:225 UNION BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1858
Practice Address - Country:US
Practice Address - Phone:303-674-7171
Practice Address - Fax:303-674-1223
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1098103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation