Provider Demographics
NPI:1366456766
Name:SPECTOR, STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 WEST MAPLE RD
Mailing Address - Street 2:SUITE C307
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-539-8018
Mailing Address - Fax:248-539-8032
Practice Address - Street 1:5600 WEST MAPLE RD
Practice Address - Street 2:SUITE C307
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-539-8018
Practice Address - Fax:248-539-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP04910001OtherMEDICARE PART B