Healthcare Provider Details

I. General information

NPI: 1003194408
Provider Name (Legal Business Name): MEGAN SPINA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6580 MONONA DR # 1104
MONONA WI
53716-4032
US

IV. Provider business mailing address

6580 MONONA DR # 1104
MONONA WI
53716-4032
US

V. Phone/Fax

Practice location:
  • Phone: 917-287-4791
  • Fax:
Mailing address:
  • Phone: 917-287-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8758-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: