Provider Demographics
NPI:1457603847
Name:BELTRAN, MYRIAM (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SIMPSON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2360
Mailing Address - Country:US
Mailing Address - Phone:720-878-0397
Mailing Address - Fax:
Practice Address - Street 1:400 E SIMPSON ST STE 210
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2360
Practice Address - Country:US
Practice Address - Phone:720-878-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA1017751041C0700X
CO099274331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor