| Doctor Name: | BRAD SPICKARD |
| NPI Number: | 1003166323 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 9891 |
| Business Practice Address: | 49b Carleton St Newton, MA - 024581604 |
| Business Phone Number: | 6172074124 |
| Business Fax Number: | |
| Mailing Address: | 49b Carleton St, NEWTON |
| State: | MA |
| Postal Code: | 024581604 |
| Phone Number: | 6172074124 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2012 |
| NPI Last Update Date: | 08/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 9891 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |