MEDICARE: MR. MICHAEL C. SPIELDENNER 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	101YM0800X	Mental Health Counselor	R043527-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123555P	OTHER	NY	HIP

General Provider Information

NPI Number	:	1760422430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL C. SPIELDENNER LCSW

Provider Business Mailing Address
First Line	:	26 COURT ST
Second Line	:	STE 502
City	:	BROOKLYN
State	:	NY
Zip	:	11242
Country	:	US
Telephone Number	:	718-694-8209
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST
Second Line	:	STE 502
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1105
Country	:	US
Telephone Number	:	718-694-8209
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/04/2020

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