Healthcare Provider Details

I. General information

NPI: 1235290362
Provider Name (Legal Business Name): HENRIETTA H FILIPAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/14/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482
FPO AP
96362
JP

IV. Provider business mailing address

PSC 482
FPO AP
96362
US

V. Phone/Fax

Practice location:
  • Phone: 6430228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.007657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: