MEDICARE: ANDRENE SPENCER-LOVEJOY PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	027972	NY

General Provider Information

NPI Number	:	1427579713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRENE SPENCER-LOVEJOY PSYD

Provider Business Mailing Address
First Line	:	30 RHODA AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 E 85TH ST APT 6C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-3099
Country	:	US
Telephone Number	:	347-378-4588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	05/26/2026

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