Provider Demographics
NPI:1174065122
Name:SPANICCIATI, ROBERT MICHAEL (CAP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:SPANICCIATI
Suffix:
Gender:M
Credentials:CAP
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Mailing Address - Street 1:1280 N CONGRESS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6377
Mailing Address - Country:US
Mailing Address - Phone:561-228-1598
Mailing Address - Fax:844-715-4884
Practice Address - Street 1:1280 N CONGRESS AVE
Practice Address - Street 2:SUITE 108A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6377
Practice Address - Country:US
Practice Address - Phone:561-228-1598
Practice Address - Fax:844-715-4884
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL4392101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)