| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CAROLYN LASTRA BLACK | 1508331257 | 2024-10-13 |
Carolyn Lastra Black is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1508331257. Registration indicates Carolyn Lastra Black is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Psychologist (Behavioral Health & Social Service Providers, Psychologist) (Psychologist, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychologist, Behavioral Health & Social Service Providers) Access to Mental Health/Behavioral Health Providers (Behavioral Health & Social Service Providers, Psychologist) (Behavioral Health & Social Service Providers, Psychologist) (Psychologist: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychologist Clinical, Behavioral Health & Social Service Providers) (Psychologist, )
| Entity Type | Individual |
| Provider Name | Dr. Carolyn Lastra Black PSYD, LP |
| Other Provider Name | Carolyn Lastra Raffel |
| Practice Office Address | 1555 S HAVANA ST UNIT F-336 DENVER, CO US |
| Practice Office Telephone | 7205154291 |
| Mailing Address | 1555 S HAVANA ST UNIT F-336 AURORA, CO 800125004 US |
| Business Telephone | 7205154291 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 2450 S Vine St | Denver, CO 802105264 | 3038713626 |
| 8931 Huron St | Thornton, CO 802606806 | 3038533500 |
| Code | Practice | License No State |
|---|---|---|
| 103T00000X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Psychologist Behavioral Health & Social Service Providers Psychologist Psychologist Behavioral Health/Substance Abuse/Psychiatry Psychologist Behavioral Health & Social Service Providers | PSY.0006222
CO |
| 103TC0700X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Psychologist Behavioral Health & Social Service Providers Psychologist Psychologist: Clinical Behavioral Health/Substance Abuse/Psychiatry Psychologist Clinical Behavioral Health & Social Service Providers Psychologist | PSY.0006222
CO |