Provider Demographics
NPI:1538227954
Name:LUSTIG, ELAINE ESTER (PHD)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:ESTER
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 SO PARKER RD
Mailing Address - Street 2:#562
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2901
Mailing Address - Country:US
Mailing Address - Phone:303-369-7770
Mailing Address - Fax:303-369-7673
Practice Address - Street 1:3035 SO PARKER RD
Practice Address - Street 2:#562
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2901
Practice Address - Country:US
Practice Address - Phone:303-369-7770
Practice Address - Fax:303-369-7673
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical