Basic Information
| Provider Information | |||||||||
| NPI: | 1508097965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAPERT-SPIVACK | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 GREENRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106051201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149651109 | ||||||||
| FaxNumber: | 9149977942 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 DOCK ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149651109 | ||||||||
| FaxNumber: | 9149659705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 019279 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 00355940 | 01 | NY | AGENCY MEDICAID ID | OTHER | WVE061 | 01 | NY | AGENCY MEDICARE ID | OTHER | 1285628552 | 01 | NY | AGENCY NPI # | OTHER |