Provider Demographics
NPI:1770104325
Name:DEROSA, JENNA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DEROSA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 INDEPENDENCE ST STE 225
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6849
Mailing Address - Country:US
Mailing Address - Phone:402-306-9552
Mailing Address - Fax:
Practice Address - Street 1:4891 INDEPENDENCE ST STE 225
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6849
Practice Address - Country:US
Practice Address - Phone:402-306-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health