Autumn Tree Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

727 Issued in CO

Legal business name

AUTUMN TREE THERAPY

Practice address

2935 Baseline Rd
Ste. 302
Boulder, CO 80303-2366

Phone

(303) 875-2364

NPI assigned

Mar 21, 2017

Last updated

Mar 21, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carley Cohen-Fox, MSW LCSW CMCNPI 1053644922

Title

Clinician/Owner

Phone

(303) 875-2364

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carley Cohen-Fox, MSW LCSW CMC

  • Clinical Social Worker
  • Boulder, CO
  • NPI 1053644922
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490054400000",
    "number": "1750812889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 BASELINE RD",
            "address_2": "STE. 302",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032366",
            "telephone_number": "303-875-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 BASELINE RD",
            "address_2": "STE. 302",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803032366",
            "telephone_number": "303-875-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN TREE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-03-21",
        "status": "A",
        "authorized_official_last_name": "COHEN-FOX",
        "authorized_official_first_name": "CARLEY",
        "authorized_official_title_or_position": "CLINICIAN/OWNER",
        "authorized_official_telephone_number": "303-875-2364",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW LCSW CMC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54105081",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Boulder, CO
• Providers in Boulder, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.