Provider Demographics
NPI:1841885381
Name:KITEY, REBECCA (LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KITEY
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 1:12655 W BAYAUD AVE UNIT 43
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2025
Mailing Address - Country:US
Mailing Address - Phone:720-295-8133
Mailing Address - Fax:
Practice Address - Street 1:12157 W CEDAR DR STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2105
Practice Address - Country:US
Practice Address - Phone:720-295-8133
Practice Address - Fax:303-985-7882
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9923433104100000X
CO00099234331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty