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General NPI Number Information
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NPI Number | 1093880965
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Entity Type | Individual
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Provider Name | STEVE ARTHUR SPACCARELLI PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2006
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 6551 NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1020
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Country | US
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Telephone | 708-969-2575
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Fax | 708-445-0495
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Provider Business Mailing Address
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Address Line | 427 LENOX ST
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City | OAK PARK
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State | IL
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Zip | 60302-1339
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Country | US
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Telephone | 708-969-2575
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Fax | 708-445-0495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07004918
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License Number State | IL
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