MEDICARE: CLAUDETTE K SPENST MSW., LSW

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	104100000X	Social Worker	44SL05653000	NJ
2	104100000X	Social Worker	040598-1	NY

General Provider Information

NPI Number	:	1588091896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDETTE K SPENST MSW., LSW

Provider Business Mailing Address
First Line	:	272 WHITEMAN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 WHITEMAN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5631
Country	:	US
Telephone Number	:	201-947-5187
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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