Provider Demographics
NPI:1922473727
Name:SPIDELL, JEREMY FRANK (MSW)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:FRANK
Last Name:SPIDELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROSEBAY LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3407
Mailing Address - Country:US
Mailing Address - Phone:336-254-6505
Mailing Address - Fax:
Practice Address - Street 1:20 ROSEBAY LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3407
Practice Address - Country:US
Practice Address - Phone:336-254-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPOO98631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical