Provider Demographics
NPI:1477535706
Name:CHILD AND FAMILY PSYCHOLOGISTS PA
Entity Type:Organization
Organization Name:CHILD AND FAMILY PSYCHOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPERO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:954-587-7520
Mailing Address - Street 1:350 NW 70TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2349
Mailing Address - Country:US
Mailing Address - Phone:954-587-7520
Mailing Address - Fax:954-587-7527
Practice Address - Street 1:350 NW 70TH AVE
Practice Address - Street 2:STE A
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2349
Practice Address - Country:US
Practice Address - Phone:954-587-7520
Practice Address - Fax:954-587-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73376OtherBCBS
FL73376OtherBCBS