Provider Demographics
NPI:1740643139
Name:DEFLIPPO, MICHELE
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:DEFLIPPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 OMEGA RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1226
Mailing Address - Country:US
Mailing Address - Phone:510-999-4410
Mailing Address - Fax:
Practice Address - Street 1:2120 OMEGA RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1226
Practice Address - Country:US
Practice Address - Phone:510-999-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst