Provider Demographics
NPI:1760422430
Name:SPIELDENNER, MICHAEL C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:SPIELDENNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:C
Other - Last Name:SPIELDENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:26 COURT ST
Mailing Address - Street 2:STE 502
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242
Mailing Address - Country:US
Mailing Address - Phone:718-694-8209
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:STE 502
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1105
Practice Address - Country:US
Practice Address - Phone:718-694-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043527-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123555POtherHIP
NY123555POtherHIP