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General NPI Number Information
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NPI Number | 1578658522
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Entity Type | Individual
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Provider Name | PATRICIA A. MIRIPOL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/11/2020
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Provider Practice Location Address
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Address Line | 4420 LIMESTONE RD STE 201A
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City | WILMINGTON
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State | DE
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Zip | 19808-2005
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Country | US
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Telephone | 302-633-6416
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Fax | 302-998-7660
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Provider Business Mailing Address
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Address Line | 463 STELLA DR
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City | HOCKESSIN
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State | DE
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Zip | 19707-1922
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Country | US
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Telephone | 302-633-6416
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Fax | 302-998-7660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS005845L INACTIVE
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.003124
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | B10000237
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License Number State | DE
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