Provider Demographics
NPI:1982812749
Name:GLASS, LAVADA S (LCSW, CAC III)
Entity Type:Individual
Prefix:MS
First Name:LAVADA
Middle Name:S
Last Name:GLASS
Suffix:
Gender:F
Credentials:LCSW, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2090
Mailing Address - Country:US
Mailing Address - Phone:303-637-4218
Mailing Address - Fax:303-771-2148
Practice Address - Street 1:3939 E ARAPAHOE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2090
Practice Address - Country:US
Practice Address - Phone:303-637-4218
Practice Address - Fax:303-771-2148
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9895511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60854324OtherUNITED HEALTH CARE ID