Provider Demographics
NPI:1427115443
Name:SPENCERPORT CSD
Entity type:Organization
Organization Name:SPENCERPORT CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-349-5101
Mailing Address - Street 1:71 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1825
Mailing Address - Country:US
Mailing Address - Phone:585-349-5101
Mailing Address - Fax:585-349-5011
Practice Address - Street 1:71 LYELL AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1825
Practice Address - Country:US
Practice Address - Phone:585-349-5101
Practice Address - Fax:585-349-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01411605Medicaid