Healthcare Provider Details

I. General information

NPI: 1881140002
Provider Name (Legal Business Name): RENEE SPIVEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 SUTPHIN BLVD
JAMAICA NY
11434-1020
US

IV. Provider business mailing address

11515 SUTPHIN BLVD
JAMAICA NY
11434-1020
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-6009
  • Fax: 347-682-4302
Mailing address:
  • Phone: 718-765-6009
  • Fax: 347-682-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number098158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: