Provider Demographics
NPI:1053440438
Name:SPIVAK, STEVEN BERNARD (MS, CAS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BERNARD
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E NECK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1567
Mailing Address - Country:US
Mailing Address - Phone:631-673-6989
Mailing Address - Fax:
Practice Address - Street 1:115 E NECK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1567
Practice Address - Country:US
Practice Address - Phone:631-673-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health