Basic Information
| Provider Information | |||||||||
| NPI: | 1245313568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPITZ | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024535356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818948440 | ||||||||
| FaxNumber: | 7818941202 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024535356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818948440 | ||||||||
| FaxNumber: | 7818941202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 106158 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1004745 | 01 | NHP | OTHER | P0558301 | 01 | MA | MEDICARE PTAN | OTHER | 042611055 | 01 | TAX ID | OTHER | 99618201 | 01 | NETWORK HEALTH | OTHER | P10329 | 01 | MA | BCBS | OTHER | 1303287 | 05 | MA | MEDICAID | 1303287 | 01 | MA | MBHD | OTHER | M18633 | 01 | MA | BCBS | OTHER | 703136 | 01 | TUFTS | OTHER | NP01332 | 01 | BOSTON MED | OTHER | P0558302 | 01 | MA | MEDICARE PTAN | OTHER |