Provider Demographics
NPI:1629420815
Name:SPATARO, PATRICIA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SPATARO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1128
Mailing Address - Country:US
Mailing Address - Phone:518-225-4921
Mailing Address - Fax:
Practice Address - Street 1:26 BLUFF RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1128
Practice Address - Country:US
Practice Address - Phone:518-225-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18000415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health