Provider Demographics
NPI:1275549271
Name:SPECTOR, JOSEPH M (PH D)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LYNDELL TERR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6205
Mailing Address - Country:US
Mailing Address - Phone:530-759-1929
Mailing Address - Fax:530-759-1929
Practice Address - Street 1:2050 LYNDELL TERR
Practice Address - Street 2:SUITE 130
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6205
Practice Address - Country:US
Practice Address - Phone:530-759-1929
Practice Address - Fax:530-759-1929
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9009103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66488ZOtherBLUE SHIELD