Provider Demographics
NPI:1427035021
Name:SPICUZZA, CYNTHIA RICHARDSON (PHD, LP)
Entity Type:Individual
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First Name:CYNTHIA
Middle Name:RICHARDSON
Last Name:SPICUZZA
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Gender:F
Credentials:PHD, LP
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Mailing Address - Street 1:2550 UNIVERSITY AVE WEST
Mailing Address - Street 2:STE 229N
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:651-645-3115
Mailing Address - Fax:651-645-2752
Practice Address - Street 1:2550 UNIVERSITY AVE WEST
Practice Address - Street 2:STE 229N
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-645-3115
Practice Address - Fax:651-645-2752
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP3814103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN141T1SPOtherBCBS OF MN
MN6173368OtherMEDICA