Provider Demographics
NPI:1992821276
Name:SPIDALIERE, WILLIAM DARYL (PSYD, LCMHC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DARYL
Last Name:SPIDALIERE
Suffix:
Gender:M
Credentials:PSYD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TEAK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1465
Mailing Address - Country:US
Mailing Address - Phone:603-396-6050
Mailing Address - Fax:603-882-5232
Practice Address - Street 1:28 TEAK DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1465
Practice Address - Country:US
Practice Address - Phone:603-396-6050
Practice Address - Fax:603-882-5232
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 141 LCMHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008842Medicaid