Provider Demographics
NPI:1003039470
Name:SPECTOR, NANCIE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCIE
Middle Name:R
Last Name:SPECTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6003
Mailing Address - Country:US
Mailing Address - Phone:203-972-9009
Mailing Address - Fax:
Practice Address - Street 1:112 ADAMS LN
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6003
Practice Address - Country:US
Practice Address - Phone:203-972-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1195103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent