Provider Demographics
NPI:1871516633
Name:GREENFIELD, ALLAN RICHARD (MS, MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:RICHARD
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MS, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N WEBER ST
Mailing Address - Street 2:STE 270
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7537
Mailing Address - Country:US
Mailing Address - Phone:719-634-5800
Mailing Address - Fax:719-578-5596
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:STE 270
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7537
Practice Address - Country:US
Practice Address - Phone:719-634-5800
Practice Address - Fax:719-578-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9891441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COR20031Medicare UPIN
CO804546Medicare PIN