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General NPI Number Information
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NPI Number | 1215422274
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Entity Type | Individual
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Provider Name | BRYANTA L SPENCER LISW-S
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 12808 THRAVES AVE
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-4432
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Country | US
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Telephone | 216-303-4196
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Fax |
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Provider Business Mailing Address
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Address Line | 12401 ROCKSIDE RD UNIT 25611
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-7331
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Country | US
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Telephone | 216-303-4196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1700519
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License Number State | OH
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