Provider Demographics
NPI:1578658522
Name:MIRIPOL, PATRICIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MIRIPOL
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 1:463 STELLA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1922
Mailing Address - Country:US
Mailing Address - Phone:302-633-6416
Mailing Address - Fax:302-998-7660
Practice Address - Street 1:4420 LIMESTONE RD STE 201A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2005
Practice Address - Country:US
Practice Address - Phone:302-633-6416
Practice Address - Fax:302-998-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005845L INACTIVE103TC0700X
IL071.003124103TC0700X
DEB10000237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE166653OtherVALUE OPTIONS
DE173302OtherCOMPPSYCH
DE217610OtherMANAGED HEALTH NETWORK
DEGH08/521603-01OtherBLUE CROSS MD
DE022451000OtherMAGELLAN MIS #
DE4335959OtherAETNA INSURANCE #
DE041150000OtherMAGELLAN/AMERIHEALTH
DE0411500000OtherPERSONAL CHOICE #
DE2052651OtherCIGNA #