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General NPI Number Information
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NPI Number | 1396540415
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Entity Type | Organization
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Legal Business Name | SP CLINICAL SERVICES LCSW, PLLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 8469 SENECA TPKE
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City | NEW HARTFORD
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State | NY
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Zip | 13413-4902
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Country | US
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Telephone | 315-525-8048
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Fax |
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Provider Business Mailing Address
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Address Line | 8026 CIDER ST
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City | ORISKANY
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State | NY
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Zip | 13424-3704
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Country | US
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Telephone | 315-525-8048
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SONYA LISSETTE PIERSMA
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Credential | LCSW
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Telephone | 315-525-8048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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