Provider Demographics
NPI:1891892824
Name:SPEROPOULOS, THEODORA (LCSW)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:SPEROPOULOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 SW 35TH TER
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8260
Mailing Address - Country:US
Mailing Address - Phone:305-778-5692
Mailing Address - Fax:
Practice Address - Street 1:4956 SW 35TH TER
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-8260
Practice Address - Country:US
Practice Address - Phone:305-778-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW000034351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical