Provider Demographics
NPI:1114412921
Name:SPEDALERI, JENNAFER LAUREN (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:JENNAFER
Middle Name:LAUREN
Last Name:SPEDALERI
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MISS
Other - First Name:JENNAFER
Other - Middle Name:LAUREN
Other - Last Name:ZITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 LAKE AVE S
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1001
Mailing Address - Country:US
Mailing Address - Phone:631-636-0620
Mailing Address - Fax:631-656-8823
Practice Address - Street 1:68 VILLAGE LINE RD
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1511
Practice Address - Country:US
Practice Address - Phone:631-482-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional