Healthcare Provider Details

I. General information

NPI: 1194050450
Provider Name (Legal Business Name): SUZANNE SPENCE CUITE LCSW-R, EDM, SIFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 SCHERGER AVE
EAST PATCHOGUE NY
11772-5065
US

IV. Provider business mailing address

908 SCHERGER AVE
EAST PATCHOGUE NY
11772-5065
US

V. Phone/Fax

Practice location:
  • Phone: 631-838-5109
  • Fax:
Mailing address:
  • Phone: 631-838-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR069557-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: