MEDICARE: CHERYL JANE KASPRZAK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY6104	FL
2	103TB0200X	Cognitive & Behavioral Psychologist	PY6194	FL
3	103TC0700X	Clinical Psychologist	PY6194	FL
4	103TC2200X	Clinical Child & Adolescent Psychologist	PY6194	FL
5	103T00000X	Psychologist	PY6194	FL

General Provider Information

NPI Number	:	1134100381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL JANE KASPRZAK PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 990461
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6065
Country	:	US
Telephone Number	:	239-262-4543
Fax Number	:	239-949-9555

Provider Business Practice Location Address
First Line	:	3227 HORSESHOE DR S
Second Line	:	SUITE 101
City	:	NAPLES
State	:	FL
Zip	:	34104-6114
Country	:	US
Telephone Number	:	239-262-4543
Fax Number	:	239-949-9555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	11/30/2012

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