Healthcare Provider Details

I. General information

NPI: 1053928895
Provider Name (Legal Business Name): LILLIAN SERINA SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 HIGHVIEW RD
MONROE NY
10950-5243
US

IV. Provider business mailing address

38 HIGHVIEW RD
MONROE NY
10950-5243
US

V. Phone/Fax

Practice location:
  • Phone: 518-406-0818
  • Fax:
Mailing address:
  • Phone: 845-774-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number105565
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: