Provider Demographics
NPI:1205930310
Name:AMMIRATO, SAMUEL P (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:P
Last Name:AMMIRATO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 1007
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3808
Mailing Address - Country:US
Mailing Address - Phone:303-757-2430
Mailing Address - Fax:303-753-9668
Practice Address - Street 1:1776 S JACKSON ST STE 1007
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3808
Practice Address - Country:US
Practice Address - Phone:303-757-2430
Practice Address - Fax:303-753-9668
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist