Basic Information
| Provider Information | |||||||||
| NPI: | 1659049872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIANO | ||||||||
| FirstName: | THESSA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4861 S CARSON ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800151275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019822149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8111 E LOWRY BLVD | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208489500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2021 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW.09927161 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.