Provider Demographics
NPI:1134100381
Name:KASPRZAK, CHERYL JANE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JANE
Last Name:KASPRZAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990461
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6065
Mailing Address - Country:US
Mailing Address - Phone:239-262-4543
Mailing Address - Fax:239-949-9555
Practice Address - Street 1:3227 HORSESHOE DR S
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6114
Practice Address - Country:US
Practice Address - Phone:239-262-4543
Practice Address - Fax:239-949-9555
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6104103T00000X
FLPY6194103TB0200X, 103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent