Provider Demographics
NPI:1235309923
Name:DELLARIPA, CLOY RENEE (MC)
Entity type:Individual
Prefix:MS
First Name:CLOY
Middle Name:RENEE
Last Name:DELLARIPA
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S MONTEZUMA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4712
Mailing Address - Country:US
Mailing Address - Phone:567-202-7267
Mailing Address - Fax:
Practice Address - Street 1:240 S MONTEZUMA ST STE 100
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4712
Practice Address - Country:US
Practice Address - Phone:928-237-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008006385101YP2500X
AZLPC-21440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional