Provider Demographics
NPI:1578241212
Name:SPANOS, CHRISTOPH N (BA, MA, PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPH
Middle Name:N
Last Name:SPANOS
Suffix:
Gender:M
Credentials:BA, MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 LEXINGTON MEWS
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1348
Mailing Address - Country:US
Mailing Address - Phone:732-655-4235
Mailing Address - Fax:
Practice Address - Street 1:297 WESTWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3144
Practice Address - Country:US
Practice Address - Phone:732-655-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NJ35SI00760800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist