Provider Demographics
NPI:1154192839
Name:BIRRUETA, MAIRA (PHD)
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:BIRRUETA
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 1:7471 E 29TH PL UNIT 3001
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2817
Mailing Address - Country:US
Mailing Address - Phone:509-961-7787
Mailing Address - Fax:
Practice Address - Street 1:900 AURARIA PKWY
Practice Address - Street 2:SUITE #651
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:760-303-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006174103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling