Individual
JEFFREY WITHERSPOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
98 DIVISION AVE, MASSAPEQUA, NY 11758-7101
(516) 398-7298
Mailing address
98 DIVISION AVE, MASSAPEQUA, NY 11758-7101
(516) 398-7298
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6560
NY
Other
Enumeration date
03/31/2015
Last updated
03/31/2015
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