MEDICARE: DR. KRISTINE V. SPANO 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	103TC0700X	Clinical Psychologist	026023-01	NY
2	103TC0700X	Clinical Psychologist	018724	PA

General Provider Information

NPI Number	:	1467944470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE V. SPANO PSY.D.

Provider Business Mailing Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:	267-358-6155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST STE 1414
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3610
Country	:	US
Telephone Number	:	267-358-6155
Fax Number	:

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

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	08/20/2024

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