Healthcare Provider Details

I. General information

NPI: 1417608555
Provider Name (Legal Business Name): SABRINA SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DRIVE TRAUMA FOLLOW UP CLINIC
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

903 W MARTIN ST # MS 49-2
SAN ANTONIO TX
78207-0903
US

V. Phone/Fax

Practice location:
  • Phone: 210-743-2900
  • Fax: 210-358-8451
Mailing address:
  • Phone: 210-358-3427
  • Fax: 210-358-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number55261
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: