Provider Demographics
NPI:1366216889
Name:WUTH, ALICIA SAMANIEGO (PSYD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SAMANIEGO
Last Name:WUTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 E ALAMEDA CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3201
Mailing Address - Country:US
Mailing Address - Phone:303-810-1956
Mailing Address - Fax:
Practice Address - Street 1:2565 E ALAMEDA CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3201
Practice Address - Country:US
Practice Address - Phone:303-810-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005519103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist