Provider Demographics
NPI:1366059214
Name:SPIELMAN, JENNIFER MARCI
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARCI
Last Name:SPIELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RIGA LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3406
Mailing Address - Country:US
Mailing Address - Phone:631-721-3640
Mailing Address - Fax:
Practice Address - Street 1:8 RIGA LN
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3406
Practice Address - Country:US
Practice Address - Phone:631-721-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053773-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker