Provider Demographics
NPI:1336370600
Name:AMESQUITA, LORRAINE OMEGA (BA)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:OMEGA
Last Name:AMESQUITA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3060
Mailing Address - Country:US
Mailing Address - Phone:586-764-6211
Mailing Address - Fax:
Practice Address - Street 1:2895 ELM ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-3060
Practice Address - Country:US
Practice Address - Phone:586-764-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health