Provider Demographics
NPI:1912055633
Name:SPADA, DONNA (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SPADA
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 1:148 ISLIP AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3234
Mailing Address - Country:US
Mailing Address - Phone:631-224-7735
Mailing Address - Fax:631-957-6768
Practice Address - Street 1:148 ISLIP AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3234
Practice Address - Country:US
Practice Address - Phone:631-224-7735
Practice Address - Fax:631-957-6768
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044372-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical