Provider Demographics
NPI:1093927428
Name:SPECTOR, JACK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:SPECTOR
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 1:1101 SAINT PAUL ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2619
Mailing Address - Country:US
Mailing Address - Phone:301-725-0055
Mailing Address - Fax:866-855-7976
Practice Address - Street 1:1101 SAINT PAUL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2619
Practice Address - Country:US
Practice Address - Phone:301-725-0055
Practice Address - Fax:866-855-7976
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2367103G00000X, 103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic