Basic Information
| Provider Information | |||||||||
| NPI: | 1174584213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOFORENKO | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 BROADWAY | ||||||||
| Address2: | SENIOR COUNSELING GROUP | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032962244 | ||||||||
| FaxNumber: | 3032961709 | ||||||||
| Practice Location | |||||||||
| Address1: | 4686 E ASBURY CIRCLE | ||||||||
| Address2: | AMBERWOOD COURT | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037561566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 469 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.