Provider Demographics
NPI:1700909405
Name:SIPSAS-HERRMANN, ATHANASIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIA
Middle Name:
Last Name:SIPSAS-HERRMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ATHANASIA
Other - Middle Name:
Other - Last Name:SIPSAS-HERRMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7220 N 16TH ST STE I
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5253
Mailing Address - Country:US
Mailing Address - Phone:602-824-8804
Mailing Address - Fax:602-581-7181
Practice Address - Street 1:7220 N 16TH ST STE I
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5253
Practice Address - Country:US
Practice Address - Phone:602-824-8804
Practice Address - Fax:602-581-7181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3754103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool