Provider Demographics
NPI:1194954982
Name:SPADA, DANA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:SPADA
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1722
Mailing Address - Country:US
Mailing Address - Phone:516-286-4378
Mailing Address - Fax:
Practice Address - Street 1:73 MERCER RD
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1722
Practice Address - Country:US
Practice Address - Phone:516-286-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65847291041C0700X
NJ4SL065981001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical