Provider Demographics
NPI:1790068302
Name:MCSPIRITT, JANICE RUSSO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:RUSSO
Last Name:MCSPIRITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:175 HAIGHT RD WEBUTUCK ELEMENTARY SCHOOL
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501
Mailing Address - Country:US
Mailing Address - Phone:845-373-4122
Mailing Address - Fax:845-373-4125
Practice Address - Street 1:175 HAIGHT RD
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5208
Practice Address - Country:US
Practice Address - Phone:845-373-4122
Practice Address - Fax:845-373-4125
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039033-11041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool