Healthcare Provider Details

I. General information

NPI: 1114114519
Provider Name (Legal Business Name): CLAIRESSA M SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date: 06/24/2026
Reactivation Date: 07/28/2026

III. Provider practice location address

16408 VALENCIA AVE UNIT 815
FONTANA CA
92335-7854
US

IV. Provider business mailing address

16408 VALENCIA AVE UNIT 815
FONTANA CA
92335-7854
US

V. Phone/Fax

Practice location:
  • Phone: 562-753-1836
  • Fax:
Mailing address:
  • Phone: 562-753-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: