Provider Demographics
NPI:1548495401
Name:GANGEMI, STEPHANIE ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:GANGEMI
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 1:6225 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:CO
Mailing Address - Zip Code:80809-1349
Mailing Address - Country:US
Mailing Address - Phone:719-233-8735
Mailing Address - Fax:
Practice Address - Street 1:2502 W COLORADO AVE STE 211
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3068
Practice Address - Country:US
Practice Address - Phone:719-233-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099233411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical