Provider Demographics
NPI:1770590291
Name:HENSLEY-SPERA, MARIA J (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:HENSLEY-SPERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:J
Other - Last Name:SPERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:26 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-5005
Mailing Address - Country:US
Mailing Address - Phone:631-294-1540
Mailing Address - Fax:
Practice Address - Street 1:475 E MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-294-1540
Practice Address - Fax:631-294-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR056541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR056541-1OtherLCSW LICENSE
NYN554D1Medicare ID - Type UnspecifiedNY-MEDICARE