Provider Demographics
NPI:1447575634
Name:BRTEK, ANNE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:BRTEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIRCLE
Mailing Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-8761
Mailing Address - Country:US
Mailing Address - Phone:719-291-8474
Mailing Address - Fax:719-526-0608
Practice Address - Street 1:1650 COCHRANE CIRCLE
Practice Address - Street 2:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-8761
Practice Address - Country:US
Practice Address - Phone:719-526-3346
Practice Address - Fax:719-526-0608
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2314103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent