Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 000351 | CT |
Y | 103T00000X | Psychologist | 000351 | CT |
N | 102L00000X | Psychologist | PR010647 | NY |
N | 103T00000X | Psychologist | PR010647 | NY |
NPI | 1003903618 |
---|---|
Provider Name | Mr. Michael David Spitzer |
First Address | Daubury, CT 06810 |
Second Address | Daubury, CT 06810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |