Physician Compare National (NPI:1063585461)

HEALTHCARE PROVIDER: JEANNA M SPATTA LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1063585461
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961832860
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200416002245
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SPATTA
	Individual professional last name
Provider First Name	JEANNA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	FORDHAM UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	934 CHASE PKWY
	Group Practice or individual's line 1 address
City	WATERBURY
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	067082916
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y