Provider Demographics
NPI:1144300781
Name:DACRES, CAROLYN LEE (RXS, CNS)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:LEE
Last Name:DACRES
Suffix:
Gender:F
Credentials:RXS, CNS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4155 E JEWELL AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4506
Mailing Address - Country:US
Mailing Address - Phone:720-290-7895
Mailing Address - Fax:888-692-9168
Practice Address - Street 1:4155 E JEWELL AVE STE 225
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4506
Practice Address - Country:US
Practice Address - Phone:720-290-7895
Practice Address - Fax:888-692-9168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77057364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC475338Medicare PIN
COP67739Medicare UPIN