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General NPI Number Information
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NPI Number | 1639229891
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Entity Type | Individual
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Provider Name | MICHELA COFFARO PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 4715 VIEWRIDGE AVE SUITE 230
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City | SAN DIEGO
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State | CA
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Zip | 92123-1658
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Country | US
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Telephone | 800-257-8715
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Fax | 800-819-1655
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Provider Business Mailing Address
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Address Line | 608 UNION ST
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City | MILTON
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State | DE
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Zip | 19968-1049
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Country | US
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Telephone | 302-684-8577
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Fax | 302-684-8577
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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 | B1-0000741
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License Number State | DE
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