Provider Demographics
NPI:1063765964
Name:SPENCER, ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3048 E BASELINE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7287
Mailing Address - Country:US
Mailing Address - Phone:480-482-1838
Mailing Address - Fax:
Practice Address - Street 1:3048 E BASELINE RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7287
Practice Address - Country:US
Practice Address - Phone:480-482-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ137031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749048Medicaid
Z91597Medicare UPIN
AZ749048Medicaid
AZZ91599Medicare UPIN