Healthcare Provider Details

I. General information

NPI: 1336734219
Provider Name (Legal Business Name): JILLAINE SPAGNOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLAINE MANCINI

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FRANKLIN ST STE 204
SCHENECTADY NY
12305-2100
US

IV. Provider business mailing address

20 UNIVERSITY PL
AMSTERDAM NY
12010-1443
US

V. Phone/Fax

Practice location:
  • Phone: 518-372-7031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: