Provider Demographics
NPI:1972915957
Name:PIGNATORE, MAYA (PHD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:PIGNATORE
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 1:1245 E LINCOLN AVE
Mailing Address - Street 2:APT 420
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4744
Mailing Address - Country:US
Mailing Address - Phone:201-602-9396
Mailing Address - Fax:
Practice Address - Street 1:1245 E LINCOLN AVE
Practice Address - Street 2:APT 420
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4744
Practice Address - Country:US
Practice Address - Phone:201-602-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical