Provider Demographics
NPI:1417203324
Name:SPIDALIERE PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SPIDALIERE PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DARYL
Authorized Official - Last Name:SPIDALIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-396-6050
Mailing Address - Street 1:28 TEAK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1465
Mailing Address - Country:US
Mailing Address - Phone:603-396-6050
Mailing Address - Fax:603-882-5232
Practice Address - Street 1:28 TEAK DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1465
Practice Address - Country:US
Practice Address - Phone:603-396-6050
Practice Address - Fax:603-882-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30426889Medicaid