Provider Demographics
NPI:1053542811
Name:SPACCARELLI, NINA (MA)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:SPACCARELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 WILSHIRE BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5418
Mailing Address - Country:US
Mailing Address - Phone:213-637-5000
Mailing Address - Fax:
Practice Address - Street 1:5700 WILSHIRE BLVD STE 560
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5418
Practice Address - Country:US
Practice Address - Phone:213-637-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56781106H00000X
CALMFT105569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist