Provider Demographics
NPI:1104066752
Name:SPITZE, KERRY ELIZABETH (MS, NCC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ELIZABETH
Last Name:SPITZE
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 EVANS ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-2106
Mailing Address - Country:US
Mailing Address - Phone:315-720-8841
Mailing Address - Fax:
Practice Address - Street 1:6838 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1029
Practice Address - Country:US
Practice Address - Phone:607-218-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health