Provider Demographics
NPI:1356536809
Name:PEREA, ANDREA CONSUELO (PSYD, LCP)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CONSUELO
Last Name:PEREA
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CONSUELO
Other - Last Name:GODINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8383 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3007
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4751101YP2500X
CO3284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18684OtherKAISER COMMERCIAL NUMBER
CO52085074Medicaid
CO52085074Medicaid