Provider Demographics
NPI:1215975495
Name:SPADA, BARBARA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:SPADA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-0321
Mailing Address - Country:US
Mailing Address - Phone:845-454-4353
Mailing Address - Fax:888-965-5621
Practice Address - Street 1:449 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROSENDALE
Practice Address - State:NY
Practice Address - Zip Code:12472-0310
Practice Address - Country:US
Practice Address - Phone:845-454-4353
Practice Address - Fax:888-965-5621
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037355-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9A021Medicare PIN