Provider Demographics
NPI:1568656759
Name:LARNER, JACQUELINE LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:LARNER
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 1:3955 EAST EXPOSITION AVENUE
Mailing Address - Street 2:SUITE
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5714
Mailing Address - Country:US
Mailing Address - Phone:303-777-2201
Mailing Address - Fax:303-355-5535
Practice Address - Street 1:3955 EAST EXPOSITION AVENUE
Practice Address - Street 2:SUITE 408
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5714
Practice Address - Country:US
Practice Address - Phone:303-777-2201
Practice Address - Fax:303-355-5535
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9893631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical