Provider Demographics
NPI:1003826397
Name:SPOEHR, DOUGLAS BEAVEN (LICSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BEAVEN
Last Name:SPOEHR
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:DEPT OF PSYCHIATRY
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8501
Mailing Address - Country:US
Mailing Address - Phone:413-447-2655
Mailing Address - Fax:413-447-2656
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8501
Practice Address - Country:US
Practice Address - Phone:413-447-2655
Practice Address - Fax:413-447-2656
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200143Medicaid
MAP22142Medicare ID - Type Unspecified