Healthcare Provider Details

I. General information

NPI: 1982071924
Provider Name (Legal Business Name): GARDITH BRIA SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CONNOLLY PKWY BLDG 2B
HAMDEN CT
06514-2593
US

IV. Provider business mailing address

60 CONNOLLY PKWY BLDG 2B
HAMDEN CT
06514-2593
US

V. Phone/Fax

Practice location:
  • Phone: 203-909-6705
  • Fax:
Mailing address:
  • Phone: 203-909-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: