Provider Demographics
NPI:1922121003
Name:GRASSMAN, MARK S (MSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:GRASSMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4809
Mailing Address - Country:US
Mailing Address - Phone:303-447-2727
Mailing Address - Fax:303-444-2843
Practice Address - Street 1:1244 PINE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4809
Practice Address - Country:US
Practice Address - Phone:303-447-2727
Practice Address - Fax:303-444-2843
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9830321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical