Doctor Name: | DR. PHILLIP SPEISER |
NPI Number: | 1265652804 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 672 |
Business Practice Address: | 1125 Tremont St Roxbury Crossing, MA - 021202178 |
Business Phone Number: | 6179893135 |
Business Fax Number: | |
Mailing Address: | 15 Parkside Dr, BOSTON |
State: | MA |
Postal Code: | 021302403 |
Phone Number: | 6175243904 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 672 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |