Provider Demographics
NPI:1003582743
Name:SPILLANE, THERESE MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:MARIE
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 48TH ST APT 2M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1144
Mailing Address - Country:US
Mailing Address - Phone:646-651-0625
Mailing Address - Fax:
Practice Address - Street 1:520 W 48TH ST APT 2M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1144
Practice Address - Country:US
Practice Address - Phone:646-651-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker