Provider Demographics
NPI:1356958284
Name:MARLOWE, LAVENDER
Entity type:Individual
Prefix:
First Name:LAVENDER
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 118TH AVE SE APT H103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4171
Mailing Address - Country:US
Mailing Address - Phone:720-202-8442
Mailing Address - Fax:
Practice Address - Street 1:4810 S ZENO ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-3246
Practice Address - Country:US
Practice Address - Phone:575-202-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009923201104100000X
COCSW.099274891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker