Provider Demographics
NPI:1396803094
Name:SPADAFORA, MYRIAM ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:ANN
Last Name:SPADAFORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7392 OASIS DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8578
Mailing Address - Country:US
Mailing Address - Phone:516-849-1533
Mailing Address - Fax:
Practice Address - Street 1:7392 OASIS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8578
Practice Address - Country:US
Practice Address - Phone:516-849-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063174-11041C0700X
CO0992552331041C0700X
NY0703331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2725672OtherOXFORD