Healthcare Provider Details

I. General information

NPI: 1386477677
Provider Name (Legal Business Name): JOSEPH PETER SPANO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 JAMES ST
SYRACUSE NY
13203-2017
US

IV. Provider business mailing address

742 JAMES ST
SYRACUSE NY
13203-2017
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-2700
  • Fax: 315-703-2880
Mailing address:
  • Phone: 315-703-2700
  • Fax: 315-703-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number127249-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: