=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760930705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA SPENCER PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2016
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 EVERGREEN PL FL 10
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07018-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-349-4025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 223 JACKSON AVE
-----------------------------------------------------
City | ROCKAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07866-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-397-4291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI00677500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------