Provider Demographics
NPI:1124486048
Name:SPERO, RACHEL DAWN (PPS)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:DAWN
Last Name:SPERO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 RUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1048
Mailing Address - Country:US
Mailing Address - Phone:818-825-1788
Mailing Address - Fax:
Practice Address - Street 1:2323 ROOSEVELT BLVD
Practice Address - Street 2:#3
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-4480
Practice Address - Country:US
Practice Address - Phone:805-985-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13545103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst