Provider Demographics
NPI:1972924801
Name:VARRONE, JERRY (MA,CAC III)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:VARRONE
Suffix:
Gender:M
Credentials:MA,CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 VINDICATOR DR
Mailing Address - Street 2:APT 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3606
Mailing Address - Country:US
Mailing Address - Phone:719-229-6288
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR
Practice Address - Street 2:204
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6097
Practice Address - Country:US
Practice Address - Phone:719-633-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC 713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)