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General NPI Number Information
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NPI Number | 1528557709
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Entity Type | Individual
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Provider Name | ANDRE SPENCE MFT
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Gender | Male
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 04/11/2020
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Provider Practice Location Address
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Address Line | 66 ORCHARD ST
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City | VERNON
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State | CT
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Zip | 06066
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Country | US
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Telephone | 860-508-9565
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 FARMINGTON AVE STE 13
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2107
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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