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NPI Code Detail

MEDICARE: EILAKEISHA BEVERLY ANN SPENCER

MEDICARE:   EILAKEISHA BEVERLY ANN SPENCER
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
1101Y00000XCounselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1730639865
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILAKEISHA BEVERLY ANN SPENCER
Provider Business Mailing Address
First Line : 520 DUDLEY ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-2769
Country : US
Telephone Number : 617-543-9208
Fax Number :
Provider Business Practice Location Address
First Line : 2 GRANITE AVE STE 260
Second Line :
City : MILTON
State : MA
Zip : 02186-4381
Country : US
Telephone Number : 857-203-7001
Fax Number : 857-588-7708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 06/12/2026

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Directions to “ EILAKEISHA BEVERLY ANN SPENCER ” Practice Location

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