Provider Demographics
NPI:1649397118
Name:DE LA MATER, LERESE (MA)
Entity Type:Individual
Prefix:MS
First Name:LERESE
Middle Name:
Last Name:DE LA MATER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 S CODY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5297
Mailing Address - Country:US
Mailing Address - Phone:303-989-7338
Mailing Address - Fax:
Practice Address - Street 1:JEFFERSON CENTER FOR MENTAL HEALTH -70 EXECUTIVE CENTER
Practice Address - Street 2:4851 INDEPENDENCE STREET
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6715
Practice Address - Country:US
Practice Address - Phone:303-432-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health