Provider Demographics
NPI:1023259264
Name:PERNITZ, ELENA (LCSW)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PERNITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:GLEKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 S TAMARAC DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4360
Mailing Address - Country:US
Mailing Address - Phone:720-248-4641
Mailing Address - Fax:
Practice Address - Street 1:3201 S TAMARAC DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4360
Practice Address - Country:US
Practice Address - Phone:720-248-4641
Practice Address - Fax:303-309-6715
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9147539Medicaid
CO9147539Medicaid