Provider Demographics
NPI:1366504920
Name:SPANIOL, SUSAN (LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SPANIOL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 OLD KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-8012
Mailing Address - Country:US
Mailing Address - Phone:508-349-2475
Mailing Address - Fax:
Practice Address - Street 1:405 OLD KINGS HWY
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-8012
Practice Address - Country:US
Practice Address - Phone:508-349-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health