Provider Demographics
NPI:1164144366
Name:MESTAS DUEY, MARISA LUCIA
Entity Type:Individual
Prefix:
First Name:MARISA LUCIA
Middle Name:
Last Name:MESTAS DUEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S ULSTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-9105
Mailing Address - Country:US
Mailing Address - Phone:303-875-2338
Mailing Address - Fax:
Practice Address - Street 1:2727 BRYANT ST STE 430
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4153
Practice Address - Country:US
Practice Address - Phone:720-770-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021290101YP2500X
CO390200000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program