Healthcare Provider Details

I. General information

NPI: 1114126257
Provider Name (Legal Business Name): JAYSON JOHN SPAS PHD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WILD ROSE CT
WAKEFIELD RI
02879-5480
US

IV. Provider business mailing address

14 WILD ROSE CT
WAKEFIELD RI
02879-5480
US

V. Phone/Fax

Practice location:
  • Phone: 401-445-4676
  • Fax:
Mailing address:
  • Phone: 401-445-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1451
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: