MEDICARE: CHAD K. SPENCER MSW, LCSW, PA

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	101YP2500X	Professional Counselor	SW7140	FL

General Provider Information

NPI Number	:	1558769521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD K. SPENCER MSW, LCSW, PA

Provider Business Mailing Address
First Line	:	2816 E ROBINSON ST STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5828
Country	:	US
Telephone Number	:	813-466-8718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 E ROBINSON ST STE 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5828
Country	:	US
Telephone Number	:	813-466-8718
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MR. CHAD K. SPENCER
Credential	:	LCSW
Telephone Number	:	813-466-8718

Provider Enumeration Date	:	12/08/2014
Last Update Date	:	12/08/2014

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