Provider Demographics
NPI:1306935358
Name:LURIE, TANYA DESIREE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:DESIREE
Last Name:LURIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S HAVANA ST # 11-388
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4019
Mailing Address - Country:US
Mailing Address - Phone:720-744-2661
Mailing Address - Fax:
Practice Address - Street 1:1155 S HAVANA ST 11-388
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4019
Practice Address - Country:US
Practice Address - Phone:720-982-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW 9917751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804760Medicare ID - Type UnspecifiedNAS MEDICARE PART B