Provider Demographics
NPI:1467944470
Name:SPANO, KRISTINE V (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:V
Last Name:SPANO
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 1:1528 WALNUT ST STE 1414
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3610
Mailing Address - Country:US
Mailing Address - Phone:267-358-6155
Mailing Address - Fax:
Practice Address - Street 1:1528 WALNUT ST STE 1414
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3610
Practice Address - Country:US
Practice Address - Phone:267-358-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026023-01103TC0700X
PA018724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical