Basic Information
| Provider Information | |||||||||
| NPI: | 1689883795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CUMMINGS CTR | ||||||||
| Address2: | SUITE 266T | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789211190 | ||||||||
| FaxNumber: | 9789273724 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 CUMMINGS CTR | ||||||||
| Address2: | SUITE 266T | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789211190 | ||||||||
| FaxNumber: | 9789273724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.