MEDICARE: MAYA PIGNATORE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY.0004181	CO

General Provider Information

NPI Number	:	1972915957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA PIGNATORE PHD

Provider Business Mailing Address
First Line	:	1245 E LINCOLN AVE
Second Line	:	APT 420
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4744
Country	:	US
Telephone Number	:	201-602-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 E LINCOLN AVE
Second Line	:	APT 420
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4744
Country	:	US
Telephone Number	:	201-602-9396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	01/03/2017

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