Provider Demographics
NPI:1437453917
Name:SPIZZO, VINCENT A (LCSWR)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:SPIZZO
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HARDENBERGH AVE
Mailing Address - Street 2:
Mailing Address - City:TILLSON
Mailing Address - State:NY
Mailing Address - Zip Code:12486-1213
Mailing Address - Country:US
Mailing Address - Phone:845-332-9237
Mailing Address - Fax:845-340-0141
Practice Address - Street 1:127 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2626
Practice Address - Country:US
Practice Address - Phone:845-332-9237
Practice Address - Fax:845-340-0141
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025442-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045067Medicare PIN
NYA300062540Medicare PIN