Provider Demographics
NPI:1285683714
Name:SPADA, COLLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:SPADA
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 1:4502 SCHENLEY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2524
Mailing Address - Country:US
Mailing Address - Phone:443-668-6942
Mailing Address - Fax:443-524-0850
Practice Address - Street 1:4502 SCHENLEY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2524
Practice Address - Country:US
Practice Address - Phone:443-668-6942
Practice Address - Fax:443-524-0850
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD356P724GMedicare PIN