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1053706739
JEFFREY WITHERSPOON
MASSAPEQUA, NY
NPI
1053706739
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 6560)
Enumeration Date
2015-03-31
Last Update Date
2015-03-31
Business Address
-- JEFFREY WITHERSPOON CASAC
98 DIVISION AVE
MASSAPEQUA, NY 11758-7101
Phone number: 516-398-7298
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Mailing Address
-- JEFFREY WITHERSPOON CASAC
98 DIVISION AVE
MASSAPEQUA, NY 11758-7101
Phone number: 516-398-7298
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