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General NPI Number Information
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NPI Number | 1083881049
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Entity Type | Organization
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Legal Business Name | SPODAK, STEFANO&ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 6155 EXECUTIVE BLVD
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City | ROCKVILLE
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State | MD
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Zip | 20852-3901
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Country | US
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Telephone | 301-770-7507
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Fax | 301-770-3576
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Provider Business Mailing Address
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Address Line | 6155 EXECUTIVE BLVD
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City | ROCKVILLE
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State | MD
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Zip | 20852-3901
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Country | US
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Telephone | 301-770-7507
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Fax | 301-770-3576
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RUTH B SPODAK
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Credential | PH.D.
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Telephone | 301-770-7507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 922
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License Number State | MD
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