Provider Demographics
NPI:1235159997
Name:SPEZZANO, MARK ALLEN (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:SPEZZANO
Suffix:
Gender:M
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EPISCOPAL AVE
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1001
Mailing Address - Country:US
Mailing Address - Phone:585-624-1350
Mailing Address - Fax:
Practice Address - Street 1:3 EPISCOPAL AVE
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1001
Practice Address - Country:US
Practice Address - Phone:585-624-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP55213103TC0700X
NY055977-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical