Provider Demographics
NPI:1730140757
Name:MCCAFFREY, SHARON M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:MCCAFFREY
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 1:410 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5535
Mailing Address - Country:US
Mailing Address - Phone:303-437-7812
Mailing Address - Fax:720-494-9964
Practice Address - Street 1:410 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5535
Practice Address - Country:US
Practice Address - Phone:303-437-7812
Practice Address - Fax:720-494-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9925801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC479608Medicare PIN