Healthcare Provider Details

I. General information

NPI: 1972648079
Provider Name (Legal Business Name): EDWARD SPECTOR PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 AUBURN AVE STE. 110
BETHESDA MD
20814-2636
US

IV. Provider business mailing address

4915 AUBURN AVE STE. 110
BETHESDA MD
20814-2636
US

V. Phone/Fax

Practice location:
  • Phone: 202-441-4834
  • Fax:
Mailing address:
  • Phone: 202-441-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04197
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number04197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: