1194886911 NPI number — SUSAN SPITTAL ASHBY LCSW

Table of content: SUSAN SPITTAL ASHBY LCSW (NPI 1194886911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194886911 NPI number — SUSAN SPITTAL ASHBY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHBY
Provider First Name:
SUSAN
Provider Middle Name:
SPITTAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPITTAL
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194886911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 THORN AVE
Provider Second Line Business Mailing Address:
SPECTRUM HUMAN SERVICES
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-662-2040
Provider Business Mailing Address Fax Number:
716-662-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SPRINGVILLE COUNSELING CENTER
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14141-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-592-9301
Provider Business Practice Location Address Fax Number:
716-592-9376
Provider Enumeration Date:
12/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  070250 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)