Provider Demographics
NPI:1730394586
Name:SPITZER, STEPHEN ALAN (LICSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ALAN
Last Name:SPITZER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6096
Mailing Address - Country:US
Mailing Address - Phone:802-257-3075
Mailing Address - Fax:802-254-7447
Practice Address - Street 1:70 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6096
Practice Address - Country:US
Practice Address - Phone:802-257-3075
Practice Address - Fax:802-254-7447
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00003661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008288Medicaid