Provider Demographics
NPI:1639229891
Name:COFFARO, MICHELA (PSYD)
Entity type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:COFFARO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:ILIOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:608 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1049
Mailing Address - Country:US
Mailing Address - Phone:302-684-8577
Mailing Address - Fax:302-684-8577
Practice Address - Street 1:4715 VIEWRIDGE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical