Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2367 | MD |
N | 103TC0700X | Clinical Psychologist | 2367 | MD |
N | 103G00000X | Clinical Psychologist | 2367 | MD |
N | 103TC0700X | Clinical Psychologist | 2367 | MD |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2367 | MD |
N | 103TF0200X | Forensic Psychologist | 2367 | MD |
NPI | 1093927428 |
---|---|
Provider Name | Dr. Jack Spector |
First Address | Baltimore, MD 21202-2619 |
Second Address | Baltimore, MD 21202-2619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 08/07/2007 |