Provider Demographics
NPI:1396766945
Name:SPITZER, ALFRED CARL (MS LLP)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:CARL
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 N WAYNE RD
Mailing Address - Street 2:STE 310
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-425-0636
Mailing Address - Fax:734-425-4771
Practice Address - Street 1:8623 N WAYNE RD
Practice Address - Street 2:STE 310
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-425-0636
Practice Address - Fax:734-425-4771
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101713101YA0400X
MI6301002425103T00000X
MI6801012814104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOQ26384054Medicare ID - Type Unspecified