MEDICARE: DR. MAYA DOUGHTIE SPERNOGA 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	PSY1001455	DC

General Provider Information

NPI Number	:	1881158426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYA DOUGHTIE SPERNOGA PSY.D.

Provider Business Mailing Address
First Line	:	324 19TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-6705
Country	:	US
Telephone Number	:	202-368-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 19TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-6705
Country	:	US
Telephone Number	:	202-368-6598
Fax Number	:

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

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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