Provider Demographics
NPI:1578669495
Name:SPANO, JAMES SEBASTIAN (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SEBASTIAN
Last Name:SPANO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TWIN HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207
Mailing Address - Country:US
Mailing Address - Phone:315-247-6219
Mailing Address - Fax:315-428-0292
Practice Address - Street 1:208 TWIN HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207
Practice Address - Country:US
Practice Address - Phone:315-247-6219
Practice Address - Fax:315-428-0292
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03585611041C0700X
NYR.035856-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB9856Medicare ID - Type Unspecified