Provider Demographics
NPI:1386830115
Name:YAMSHON, MARA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:YAMSHON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E 9TH AVE STE 660S
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3926
Mailing Address - Country:US
Mailing Address - Phone:773-372-2988
Mailing Address - Fax:
Practice Address - Street 1:4500 E 9TH AVE STE 660S
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3926
Practice Address - Country:US
Practice Address - Phone:773-372-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCW20391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61771767Medicaid