Individual
DR. CAROLYN LASTRA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
992 S 4TH AVE UNIT 100-218, BRIGHTON, CO 80601-6802
(720) 515-4291
Mailing address
992 S 4TH AVE UNIT 100-218, BRIGHTON, CO 80601-6802
(720) 515-4291
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY.0006222
CO
103TC0700X
Clinical Psychologist
Primary
PSY.0006222
CO
Other
Enumeration date
10/09/2018
Last updated
09/07/2025
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