MEDICARE: TIMOTHY ANDREW SPONSLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	090714	NY

General Provider Information

NPI Number	:	1366960023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ANDREW SPONSLER LCSW

Provider Business Mailing Address
First Line	:	93 4TH AVE # 638
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-5213
Country	:	US
Telephone Number	:	646-719-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 PRINCE ST APT 203
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-2936
Country	:	US
Telephone Number	:	646-719-5645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	07/06/2021

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