Provider Demographics
NPI:1053446385
Name:SPIVAK, HOWARD B (MFT)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:B
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 TRIBUTE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4305
Mailing Address - Country:US
Mailing Address - Phone:916-536-2434
Mailing Address - Fax:916-536-2454
Practice Address - Street 1:1792 TRIBUTE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4305
Practice Address - Country:US
Practice Address - Phone:916-536-2434
Practice Address - Fax:916-536-2454
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health