Provider Demographics
NPI:1528746690
Name:SPIELBERG, IVAN (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:SPIELBERG
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 25TH ST APT 16J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5820
Mailing Address - Country:US
Mailing Address - Phone:917-701-7519
Mailing Address - Fax:
Practice Address - Street 1:365 W 25TH ST APT 16J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5820
Practice Address - Country:US
Practice Address - Phone:917-701-7519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0716191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical