Provider Demographics
NPI:1487452520
Name:BASTEDO, SPENCER (LMSW)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:BASTEDO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 35TH AVE APT 6I
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5315
Mailing Address - Country:US
Mailing Address - Phone:917-755-5619
Mailing Address - Fax:
Practice Address - Street 1:3704 91ST ST STE E
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7909
Practice Address - Country:US
Practice Address - Phone:917-755-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125205-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical