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General NPI Number Information
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NPI Number | 1356958284
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Entity Type | Individual
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Provider Name | LAVENDER MARLOWE
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Gender |
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 4810 S ZENO ST
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City | AURORA
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State | CO
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Zip | 80015-3246
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Country | US
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Telephone | 575-202-7961
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 118TH AVE SE APT H103
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City | BELLEVUE
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State | WA
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Zip | 98005-4171
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Country | US
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Telephone | 720-202-8442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0009923201
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09927489
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License Number State | CO
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