Provider Demographics
NPI:1497894687
Name:SPIEGEL, MICHAEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SPIEGEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 CROMPOND ROAD
Mailing Address - Street 2:SUITE #14
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-739-3520
Mailing Address - Fax:914-739-3520
Practice Address - Street 1:2117 CROMPOND ROAD
Practice Address - Street 2:SUITE #14
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-739-3520
Practice Address - Fax:914-739-3520
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03941611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02037227Medicaid
NYN91081Medicare ID - Type Unspecified