Provider Demographics
NPI:1053615146
Name:CHARATAN, DANA LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LEIGH
Last Name:CHARATAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:LEIGH
Other - Last Name:CHARATAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:100 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5854
Mailing Address - Country:US
Mailing Address - Phone:303-818-6144
Mailing Address - Fax:303-648-4768
Practice Address - Street 1:100 ARAPAHOE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5854
Practice Address - Country:US
Practice Address - Phone:303-818-6144
Practice Address - Fax:303-648-4768
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical