Provider Demographics
NPI:1437355021
Name:SPINNER, PATRICE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:K
Last Name:SPINNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 S SEPULVEDA BLVD
Mailing Address - Street 2:#207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3377
Mailing Address - Country:US
Mailing Address - Phone:310-281-1913
Mailing Address - Fax:310-474-6333
Practice Address - Street 1:1554 S SEPULVEDA BLVD
Practice Address - Street 2:#207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3377
Practice Address - Country:US
Practice Address - Phone:310-281-1913
Practice Address - Fax:310-474-6333
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 20628OtherLICENSE NUMBER