| Doctor Name: | DR. MARK SPELLMANN |
| NPI Number: | 1710244017 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 068120 |
| Business Practice Address: | 119 Ball Pond Rd New Fairfield, CT - 068124536 |
| Business Phone Number: | 2035467276 |
| Business Fax Number: | |
| Mailing Address: | 119 Ball Pond Rd, NEW FAIRFIELD |
| State: | CT |
| Postal Code: | 068124536 |
| Phone Number: | 2035467276 |
| Fax Number: | |
| NPI Enumeration Date: | 04/12/2012 |
| NPI Last Update Date: | 04/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 068120 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |