Provider Demographics
NPI:1699802983
Name:DENMARK, LARA S (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:S
Last Name:DENMARK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8418
Mailing Address - Country:US
Mailing Address - Phone:413-212-2354
Mailing Address - Fax:
Practice Address - Street 1:67 ROCKLAND DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8418
Practice Address - Country:US
Practice Address - Phone:413-212-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health