Provider Demographics
NPI:1881601193
Name:SPOONER, CAIRENN (LCSW-R)
Entity type:Individual
Prefix:
First Name:CAIRENN
Middle Name:
Last Name:SPOONER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:CAIRENN
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3847 MAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-1441
Mailing Address - Country:US
Mailing Address - Phone:518-300-3187
Mailing Address - Fax:
Practice Address - Street 1:3847 MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885-1441
Practice Address - Country:US
Practice Address - Phone:518-300-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00630039Medicaid