MR. Frederick Elias Persiko, M DIV., CACITI

NPI #1730320557 in Basalt, Colorado

Provider Information

NPI Number: 1730320557
Entity Type: Individual
Name: MR. Frederick Elias Persiko, M DIV., CACITI
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Credential: M DIV., CACITI
Enumeration Date: Mar 9, 2009
Last Updated: Mar 9, 2009

Practice Location

Address: 23400 TWO RIVERS ROAD
Address 2: #49
City: Basalt
State: Colorado
ZIP Code: 81621
Phone: (970) 927-5357

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Social Worker	104100000X	Primary

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