Provider Demographics
NPI:1518930684
Name:SPATARO, RACHELE L (MS)
Entity Type:Individual
Prefix:
First Name:RACHELE
Middle Name:L
Last Name:SPATARO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-4621
Mailing Address - Country:US
Mailing Address - Phone:724-543-1043
Mailing Address - Fax:724-545-1857
Practice Address - Street 1:200 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 240
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7132
Practice Address - Country:US
Practice Address - Phone:724-543-1043
Practice Address - Fax:724-545-1857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007325L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA463672OtherVALUE OPTIONS