Provider Demographics
NPI:1396540415
Name:SP CLINICAL SERVICES LCSW, PLLC
Entity type:Organization
Organization Name:SP CLINICAL SERVICES LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LISSETTE
Authorized Official - Last Name:PIERSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-525-8048
Mailing Address - Street 1:8026 CIDER ST
Mailing Address - Street 2:
Mailing Address - City:ORISKANY
Mailing Address - State:NY
Mailing Address - Zip Code:13424-3704
Mailing Address - Country:US
Mailing Address - Phone:315-525-8048
Mailing Address - Fax:
Practice Address - Street 1:8469 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-4902
Practice Address - Country:US
Practice Address - Phone:315-525-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty