Provider Demographics
NPI:1841366796
Name:SPARACIO, RICHARD THOMAS SR (EDD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:SPARACIO
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 HARVEST ROW CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8421
Mailing Address - Country:US
Mailing Address - Phone:919-656-9662
Mailing Address - Fax:984-465-4192
Practice Address - Street 1:1000 CENTRE GREEN WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2283
Practice Address - Country:US
Practice Address - Phone:919-656-9662
Practice Address - Fax:984-465-4192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100281200103T00000X, 103TC1900X, 103TP2701X
103TA0400X
NJREG. CERTIFICATION103TS0200X
NJ37F100105300106H00000X
NC4933103T00000X
ME1344103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4985303Medicaid
NJ671775Medicare UPIN
NCQ533240281Medicare PIN
NJ4985303Medicaid