Provider Demographics
NPI:1114938255
Name:FILIPPIDES, MIRANDA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:MARIA
Last Name:FILIPPIDES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2410
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-2410
Mailing Address - Country:US
Mailing Address - Phone:970-766-2000
Mailing Address - Fax:970-766-2001
Practice Address - Street 1:57 EDWARDS ACCESS ROAD
Practice Address - Street 2:SUITE # 16
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-766-2000
Practice Address - Fax:970-766-2001
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003496103TC0700X
CO3118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical