Provider Demographics
NPI:1972251783
Name:SPERO, VANESSA MICHELLE
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MICHELLE
Last Name:SPERO
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 1:65 RIVERSIDE AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4604
Mailing Address - Country:US
Mailing Address - Phone:603-770-8002
Mailing Address - Fax:
Practice Address - Street 1:800 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5926
Practice Address - Country:US
Practice Address - Phone:603-770-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health