MEDICARE: MS. CHARMAINE D SPENCER LCSW

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	1041C0700X	Clinical Social Worker	074503-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	074503-1	OTHER	NY	LICENSED SOCIAL WORKER

General Provider Information

NPI Number	:	1568686699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARMAINE D SPENCER LCSW

Provider Business Mailing Address
First Line	:	330 LENOX RD APT 7S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2258
Country	:	US
Telephone Number	:	718-287-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	596 PROSPECT PL FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4205
Country	:	US
Telephone Number	:	718-362-1450
Fax Number	:	718-638-9124

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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