Healthcare Provider Details

I. General information

NPI: 1730584152
Provider Name (Legal Business Name): WALTER SPOSKOSKI II LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 OLD WILLIAM PENN HWY STE 2B
MONROEVILLE PA
15146-1496
US

IV. Provider business mailing address

4328 OLD WILLIAM PENN HWY LOWR LEVEL
MONROEVILLE PA
15146-1496
US

V. Phone/Fax

Practice location:
  • Phone: 412-592-1254
  • Fax:
Mailing address:
  • Phone: 412-592-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018285
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: