Healthcare Provider Details

I. General information

NPI: 1417504069
Provider Name (Legal Business Name): LEAH MASS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 E 4TH AVE STE 2-126
AURORA CO
80011-8735
US

IV. Provider business mailing address

6525 GUNPARK DR STE 370-220
BOULDER CO
80301-3346
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 833-941-5047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09927318
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: