Provider Demographics
NPI:1508097965
Name:STAPERT-SPIVACK, ERIKA BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:BETH
Last Name:STAPERT-SPIVACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GREENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1201
Mailing Address - Country:US
Mailing Address - Phone:914-965-1109
Mailing Address - Fax:914-997-7942
Practice Address - Street 1:35 DOCK ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2733
Practice Address - Country:US
Practice Address - Phone:914-965-1109
Practice Address - Fax:914-965-9705
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940OtherAGENCY MEDICAID ID
NYWVE061OtherAGENCY MEDICARE ID
NY1285628552OtherAGENCY NPI #