Provider Demographics
NPI:1932486438
Name:SPITZ MARES, KIMBERLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SPITZ MARES
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 1:110 N MACLAY AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2989
Mailing Address - Country:US
Mailing Address - Phone:818-365-3660
Mailing Address - Fax:818-365-3661
Practice Address - Street 1:110 N MACLAY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2989
Practice Address - Country:US
Practice Address - Phone:818-365-3660
Practice Address - Fax:818-365-3661
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical