Provider Demographics
NPI:1124380779
Name:LEE, XIOMARA GUADALUPE (LCSW)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:GUADALUPE
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:XIOMARA
Other - Middle Name:GUADALUPE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5396 S FLANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3746
Mailing Address - Country:US
Mailing Address - Phone:303-766-8928
Mailing Address - Fax:
Practice Address - Street 1:16154 ROCK CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3305
Practice Address - Country:US
Practice Address - Phone:303-946-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical