Provider Demographics
NPI:1821161753
Name:HYMAN CISMOSKI, JUNE ROBERTA (PH D)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:ROBERTA
Last Name:HYMAN CISMOSKI
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:R
Other - Last Name:HYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:1194 W ASH
Mailing Address - Street 2:STE D
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4608
Mailing Address - Country:US
Mailing Address - Phone:970-674-0234
Mailing Address - Fax:970-686-6276
Practice Address - Street 1:1194 W ASH
Practice Address - Street 2:STE D
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4608
Practice Address - Country:US
Practice Address - Phone:970-674-0234
Practice Address - Fax:970-686-6276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07007255Medicaid
CO07007255Medicaid