MEDICARE: DR. MARK ALLEN SPEZZANO PHD, LCSW-R

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	103TC0700X	Clinical Psychologist	P55213	NY
2	1041C0700X	Clinical Social Worker	055977-1	NY

General Provider Information

NPI Number	:	1235159997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLEN SPEZZANO PHD, LCSW-R

Provider Business Mailing Address
First Line	:	3 EPISCOPAL AVE
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-1001
Country	:	US
Telephone Number	:	585-624-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 EPISCOPAL AVE
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-1001
Country	:	US
Telephone Number	:	585-624-1350
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/11/2025

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