Provider Demographics
NPI:1134934490
Name:MARQUEZ, ELENA (LSW)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 COMANCHE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1668
Mailing Address - Country:US
Mailing Address - Phone:719-406-8326
Mailing Address - Fax:
Practice Address - Street 1:4776 EAGLERIDGE CIR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2120
Practice Address - Country:US
Practice Address - Phone:719-553-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009925982101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health