Provider Demographics
NPI:1609449529
Name:NAVVAB, AMY MARYAM (LSCW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARYAM
Last Name:NAVVAB
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 W BAYAUD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2105
Mailing Address - Country:US
Mailing Address - Phone:734-276-2132
Mailing Address - Fax:
Practice Address - Street 1:2737 W BAYAUD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-2105
Practice Address - Country:US
Practice Address - Phone:734-276-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3230031041S0200X
COCSW.09927410104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool