Provider Demographics
NPI:1437323268
Name:WENDY JAYVANTI LCSW PC
Entity Type:Organization
Organization Name:WENDY JAYVANTI LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYVANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:720-273-0278
Mailing Address - Street 1:4490 DRIFTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3175
Mailing Address - Country:US
Mailing Address - Phone:720-273-0278
Mailing Address - Fax:
Practice Address - Street 1:390 SOUTH POTOMAC STREET
Practice Address - Street 2:SUITE C
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:720-273-0278
Practice Address - Fax:303-447-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC509458OtherMEDICARE ID NUMBER