Provider Demographics
NPI:1275615312
Name:SPIELBERG, WARREN EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EDWARD
Last Name:SPIELBERG
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 1:95 PIERREPONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2704
Mailing Address - Country:US
Mailing Address - Phone:718-855-7020
Mailing Address - Fax:718-625-1744
Practice Address - Street 1:95 PIERREPONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2704
Practice Address - Country:US
Practice Address - Phone:718-855-7020
Practice Address - Fax:718-625-1744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009043103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist