Provider Demographics
NPI:1164505194
Name:SPILDE, MARY B (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:SPILDE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4603
Mailing Address - Country:US
Mailing Address - Phone:607-727-8540
Mailing Address - Fax:607-724-3865
Practice Address - Street 1:14 LEROY ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4603
Practice Address - Country:US
Practice Address - Phone:607-727-8540
Practice Address - Fax:607-724-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0221941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical