Healthcare Provider Details

I. General information

NPI: 1184834913
Provider Name (Legal Business Name): CHARLES JOSEPH SPEZZANO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 FILLMORE ST
SAN FRANCISCO CA
94115-2222
US

IV. Provider business mailing address

2252 FILLMORE ST
SAN FRANCISCO CA
94115-2222
US

V. Phone/Fax

Practice location:
  • Phone: 415-469-2090
  • Fax: 415-922-4161
Mailing address:
  • Phone: 415-469-2090
  • Fax: 415-922-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: