Provider Demographics
NPI:1184834913
Name:SPEZZANO, CHARLES JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:SPEZZANO
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 1:2252 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2222
Mailing Address - Country:US
Mailing Address - Phone:415-469-2090
Mailing Address - Fax:415-922-4161
Practice Address - Street 1:2252 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2222
Practice Address - Country:US
Practice Address - Phone:415-469-2090
Practice Address - Fax:415-922-4161
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
CAPSY12449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical