MEDICARE: MS. BARBARA J SPADA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R037355-1	NY

General Provider Information

NPI Number	:	1215975495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA J SPADA LCSW

Provider Business Mailing Address
First Line	:	PO BOX 321
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-0321
Country	:	US
Telephone Number	:	845-454-4353
Fax Number	:	888-965-5621

Provider Business Practice Location Address
First Line	:	449 MAIN STREET
Second Line	:
City	:	ROSENDALE
State	:	NY
Zip	:	12472-0310
Country	:	US
Telephone Number	:	845-454-4353
Fax Number	:	888-965-5621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/01/2020

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