Provider Demographics
NPI:1356486419
Name:SPITALNY, GLORIA DIANE (EDD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:DIANE
Last Name:SPITALNY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COMMONWEALTH AVE.
Mailing Address - Street 2:SUITE 607
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2811
Mailing Address - Country:US
Mailing Address - Phone:617-266-0422
Mailing Address - Fax:617-266-1146
Practice Address - Street 1:416 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2822
Practice Address - Country:US
Practice Address - Phone:617-266-0422
Practice Address - Fax:617-266-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical