Provider Demographics
NPI:1801561600
Name:MCDONOUGH SPANO, ALISON
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:MCDONOUGH SPANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 POTOMAC RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3120
Mailing Address - Country:US
Mailing Address - Phone:302-530-6538
Mailing Address - Fax:
Practice Address - Street 1:774 CHRISTIANA RD STE 201A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4250
Practice Address - Country:US
Practice Address - Phone:302-530-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical