Provider Demographics
NPI:1972648079
Name:SPECTOR, EDWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 AUBURN AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:202-441-4834
Mailing Address - Fax:
Practice Address - Street 1:4915 AUBURN AVE
Practice Address - Street 2:STE. 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2636
Practice Address - Country:US
Practice Address - Phone:202-441-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04197103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent