Individual ProviderDavid PetersenSocial WorkerBehavioral Health & Social Service ProvidersPractice Address6200 S Syracuse Way Ste 260, Greenwood Village, CO 80111-4739(719) 332-6767PECOS EnrollmentBased on the most recent information from CMS, provider David Petersen is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1497845788Provider TypeIndividualFull NamePetersen, DavidCredentialLCSWGenderMaleSole ProprietorYesEnumeration Date10/15/2006Last Updated1/26/2023Contact InformationPractice LocationPractice Address6200 S Syracuse Way Ste 260, Greenwood Village, CO 80111-4739Phone(719) 332-6767FaxUnlisted FaxMailing LocationMailing Address415 N Tejon St, Colorado Springs, CO 80903-1101Phone(719) 332-6767FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense255ColoradoCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense81ColoradoProvider IdentifiersIDDescriptionIssuerID099366DescriptionMedicaidIssuerUnlistedColorado