Healthcare Provider Details

I. General information

NPI: 1194752121
Provider Name (Legal Business Name): KATHERINE M. SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 SEA CLIFF AVE
SEA CLIFF NY
11579-1253
US

IV. Provider business mailing address

42 LAUREL AVE
SEA CLIFF NY
11579-1916
US

V. Phone/Fax

Practice location:
  • Phone: 516-526-7205
  • Fax:
Mailing address:
  • Phone: 516-671-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070472-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: