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NPI Code Detail

MEDICARE: MR. JEFFREY MICHAEL SPITZ LCSW

MEDICARE: MR. JEFFREY MICHAEL SPITZ 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1306184312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY MICHAEL SPITZ LCSW
Provider Business Mailing Address
First Line : 172 LIBERTY STREET
Second Line :
City : NEWBURGH
State : NY
Zip : 12550
Country : US
Telephone Number : 845-342-5941
Fax Number : 845-344-2604
Provider Business Practice Location Address
First Line : 172 LIBERTY ST
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-4912
Country : US
Telephone Number : 845-342-5941
Fax Number : 845-344-2604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2013
Last Update Date : 01/25/2013

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