Provider Demographics
NPI:1962232314
Name:DISPENZA, CHAD (MA, MS, AMFT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:DISPENZA
Suffix:
Gender:M
Credentials:MA, MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2017
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-1317
Mailing Address - Country:US
Mailing Address - Phone:716-498-0890
Mailing Address - Fax:
Practice Address - Street 1:881 NEWTON ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1209
Practice Address - Country:US
Practice Address - Phone:716-498-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist