Basic Information
| Provider Information | |||||||||
| NPI: | 1912196163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DISBROW | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | HARRINGTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW CACIII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7108 S ALTON WAY | ||||||||
| Address2: | BLDG A | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036943829 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7108 S ALTON WAY | ||||||||
| Address2: | BLDG A | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036943829 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 4185 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 992227 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.