Provider Demographics
NPI:1568519775
Name:SPINELLO, THERESA MARIE (PHD, DCSW)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:SPINELLO
Suffix:
Gender:F
Credentials:PHD, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1519
Mailing Address - Country:US
Mailing Address - Phone:516-676-5620
Mailing Address - Fax:
Practice Address - Street 1:34 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2111
Practice Address - Country:US
Practice Address - Phone:516-674-8258
Practice Address - Fax:516-674-8258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040023-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1040630OtherCIGNA
NY4488427OtherOXFORD
NY6885390OtherGHI NY
NY01601014Medicaid
NY01601014Medicaid