Provider Demographics
NPI:1093178014
Name:SAMANIEGO, MARIA GUADALUPE (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GUADALUPE
Last Name:SAMANIEGO
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:LUPE
Other - Middle Name:REBEKA
Other - Last Name:SAMANIEGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD CLINICAL PSYCH
Mailing Address - Street 1:2565 E ALAMEDA CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3201
Mailing Address - Country:US
Mailing Address - Phone:303-393-1594
Mailing Address - Fax:
Practice Address - Street 1:2565 E ALAMEDA CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3201
Practice Address - Country:US
Practice Address - Phone:303-393-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical