Provider Demographics
NPI:1679162333
Name:BATES, MADELINE (LCSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RONALD REAGAN BLVD APT A302
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6466
Mailing Address - Country:US
Mailing Address - Phone:479-445-9221
Mailing Address - Fax:
Practice Address - Street 1:5100 RONALD REAGAN BLVD APT A302
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6466
Practice Address - Country:US
Practice Address - Phone:479-445-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099305001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical