Provider Demographics
NPI:1710429386
Name:MOON, LILY (LSW)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENAI
Other - Middle Name:
Other - Last Name:CARUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:9200 W CROSS DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1527 COLE BLVD STE 275
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3423
Practice Address - Country:US
Practice Address - Phone:720-706-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.00099249221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical