Provider Demographics
NPI:1043231194
Name:DENISE SPAGNOLA
Entity Type:Organization
Organization Name:DENISE SPAGNOLA
Other - Org Name:PROFESSIONAL COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAGNOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-733-0520
Mailing Address - Street 1:114 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2329
Mailing Address - Country:US
Mailing Address - Phone:315-733-0520
Mailing Address - Fax:315-733-0518
Practice Address - Street 1:114 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2329
Practice Address - Country:US
Practice Address - Phone:315-733-0520
Practice Address - Fax:315-733-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0559501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0810Medicare PIN