Provider Demographics
NPI:1578913364
Name:SPAGNOLO, PAULETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:SPAGNOLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 JARDON ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3204
Mailing Address - Country:US
Mailing Address - Phone:914-552-2868
Mailing Address - Fax:
Practice Address - Street 1:36 JARDON ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3204
Practice Address - Country:US
Practice Address - Phone:914-552-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical