Provider Demographics
NPI:1699756635
Name:SPERO, MITCHELL E (PSY D)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:E
Last Name:SPERO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NW 70TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2349
Mailing Address - Country:US
Mailing Address - Phone:954-587-7520
Mailing Address - Fax:954-587-7527
Practice Address - Street 1:350 NW 70TH AVE
Practice Address - Street 2:STE A
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2349
Practice Address - Country:US
Practice Address - Phone:954-587-7520
Practice Address - Fax:954-587-7527
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPYH4098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73376OtherBCBS