Provider Demographics
NPI:1275280760
Name:LERMA, PATRICIA ANN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LERMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:LERMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:113 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2808
Mailing Address - Country:US
Mailing Address - Phone:719-568-1232
Mailing Address - Fax:
Practice Address - Street 1:113 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2808
Practice Address - Country:US
Practice Address - Phone:719-568-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool