| Bouldertherapist.com | |
|
3450 Penrose Pl Suite 210 Boulder CO 80301-1828 | |
| (303) 444-1404 | |
| (303) 444-3491 |
| Full Name | Bouldertherapist.com |
|---|---|
| Speciality | Social Worker |
| Location | 3450 Penrose Pl, Boulder, Colorado |
| Authorized Official Name and Position | Barry Erdman (PRESIDENT) |
| Authorized Official Contact | 3034441404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bouldertherapist.com 3450 Penrose Pl Suite 210 Boulder CO 80301-1828 Ph: (303) 444-1404 | Bouldertherapist.com 3450 Penrose Pl Suite 210 Boulder CO 80301-1828 Ph: (303) 444-1404 |
| NPI Number | 1770782336 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 08/25/2015 |
| Medicare PECOS PAC ID | 9638162571 |
|---|---|
| Medicare Enrollment ID | O20040406001026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770782336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 989018 (Colorado) | Primary |
| Provider Name | Barry R Erdman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194874008 PECOS PAC ID: 5597758458 Enrollment ID: I20120215000118 |
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