Provider Demographics
NPI:1679394050
Name:JUAREZ, RAIN LATERIA SHEREE
Entity type:Individual
Prefix:
First Name:RAIN
Middle Name:LATERIA SHEREE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 E HAMPDEN AVE APT 17U
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4818
Mailing Address - Country:US
Mailing Address - Phone:615-848-4779
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 20
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8010
Practice Address - Country:US
Practice Address - Phone:615-848-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-24-385403106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician