Provider Demographics
NPI:1538676069
Name:SPATRISANO, JAIME (PHD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:SPATRISANO
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 1:188 W NORTHERN LIGHTS BLVD STE 1110
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3985
Mailing Address - Country:US
Mailing Address - Phone:907-615-4844
Mailing Address - Fax:907-615-4855
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD STE 1110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3985
Practice Address - Country:US
Practice Address - Phone:907-615-4844
Practice Address - Fax:907-615-4855
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157815103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health