Provider Demographics
NPI:1790908085
Name:HRICIK, PAM
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:HRICIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-3029
Mailing Address - Country:US
Mailing Address - Phone:720-855-3346
Mailing Address - Fax:303-433-9701
Practice Address - Street 1:2950 TENNYSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-3029
Practice Address - Country:US
Practice Address - Phone:720-855-3346
Practice Address - Fax:303-433-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9924241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25624512Medicaid