Provider Demographics
NPI:1275978660
Name:NEW SPIRIT LICENSED CLINICAL SOCIAL WORK, PLLC
Entity Type:Organization
Organization Name:NEW SPIRIT LICENSED CLINICAL SOCIAL WORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:BISHARA
Authorized Official - Last Name:CARACCIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-536-0420
Mailing Address - Street 1:142 W 2ND ST
Mailing Address - Street 2:UNIT # 1A
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2547
Mailing Address - Country:US
Mailing Address - Phone:315-216-4776
Mailing Address - Fax:315-216-4783
Practice Address - Street 1:142 W 2ND ST
Practice Address - Street 2:UNIT # 1A
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2547
Practice Address - Country:US
Practice Address - Phone:315-216-4776
Practice Address - Fax:315-216-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074567-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty