Provider Demographics
NPI:1093880965
Name:SPACCARELLI, STEVE ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:ARTHUR
Last Name:SPACCARELLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1339
Mailing Address - Country:US
Mailing Address - Phone:708-969-2575
Mailing Address - Fax:708-445-0495
Practice Address - Street 1:6551 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1020
Practice Address - Country:US
Practice Address - Phone:708-969-2575
Practice Address - Fax:708-445-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07004918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical