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1639229891 NPI number — MICHELA COFFARO PSYD

NPI Number: 1639229891
Health Care Provider/Practitioner: MICHELA COFFARO PSYD

Information about “1639229891” NPI (MICHELA COFFARO PSYD) exists in 1639229891 in HTML format HTML  |  1639229891 in plain Text format TXT  |  1639229891 in PDF (Portable Document Format) PDF  |  1639229891 in an XML format XML  formats.

NPI Number : 1639229891 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639229891",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COFFARO",
    "FirstName": "MICHELA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ILIOPOULOS",
    "OtherFirstName": "MILDRED",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PSY.D",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "608 UNION ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MILTON",
    "MailingAddressStateName": "DE",
    "MailingAddressPostalCode": "19968-1049",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "302-684-8577",
    "MailingAddressFaxNumber": "302-684-8577",
    "FirstLinePracticeLocationAddress": "4715 VIEWRIDGE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 230",
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92123-1658",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-257-8715",
    "PracticeLocationAddressFaxNumber": "800-819-1655",
    "EnumerationDate": "01/11/2007",
    "LastUpdateDate": "06/13/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "B1-0000741",
        "LicenseNumberStateCode": "DE",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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