Active NPI
Scott Spivack, LMFT, LPCC
- Marriage & Family Therapist
- Menlo Park, CA
National Provider Identifier
1063938504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 98959
- Practice address
- 800 Menlo Ave
Suite 212
Menlo Park, CA 94025 - Phone
- (650) 288-7112
- NPI assigned
- Aug 16, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4007 | CA | |
| Marriage & Family Therapist | 106H00000X | 98959 | CA | Primary |
Addresses
Primary practice location
800 Menlo Ave
Suite 212
Menlo Park, CA 94025
Mailing address
PO Box 1411
Menlo Park, CA 94026-1411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 15, 2024 through Oct 15, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4007 | CA | MD | Professional Counselor |
| 98959 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502841600000",
"number": "1063938504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1411",
"city": "MENLO PARK",
"state": "CA",
"postal_code": "940261411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MENLO AVE",
"address_2": "SUITE 212",
"city": "MENLO PARK",
"state": "CA",
"postal_code": "94025",
"telephone_number": "650-288-7112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIVACK",
"first_name": "SCOTT",
"credential": "LMFT, LPCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-16",
"last_updated": "2017-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "4007",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "98959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menlo Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.