Provider Demographics
NPI:1730113960
Name:MODERSKI, JANINE MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MARIE
Last Name:MODERSKI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 13TH STREET
Mailing Address - Street 2:AIM HOUSE
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7504
Mailing Address - Country:US
Mailing Address - Phone:303-847-4182
Mailing Address - Fax:
Practice Address - Street 1:888 13TH STREET
Practice Address - Street 2:AIM HOUSE
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7504
Practice Address - Country:US
Practice Address - Phone:303-847-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC # 4936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional