Provider Demographics
NPI:1518141464
Name:SPINA, SUSAN (CSW-R)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SPINA
Suffix:
Gender:F
Credentials:CSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417
Mailing Address - Country:US
Mailing Address - Phone:315-768-7168
Mailing Address - Fax:
Practice Address - Street 1:238 ORISKANY BLVD
Practice Address - Street 2:STE 2
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1540
Practice Address - Country:US
Practice Address - Phone:315-768-7181
Practice Address - Fax:315-768-7182
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6227983UPD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS30277Medicare UPIN