=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558769521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAD K. SPENCER MSW, LCSW, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2014
-----------------------------------------------------
Last Update Date | 12/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2816 E ROBINSON ST STE 206
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-466-8718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2816 E ROBINSON ST STE 206
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-5828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-466-8718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MR. CHAD K. SPENCER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 813-466-8718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | SW7140
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------