MEDICARE: MR. ROBERT MICHAEL SPANICCIATI CAP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4392	FL

General Provider Information

NPI Number	:	1174065122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MICHAEL SPANICCIATI CAP

Provider Business Mailing Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	SUITE 108
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:	844-715-4884

Provider Business Practice Location Address
First Line	:	1280 N CONGRESS AVE
Second Line	:	SUITE 108A
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6377
Country	:	US
Telephone Number	:	561-228-1598
Fax Number	:	844-715-4884

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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