Provider Demographics
NPI:1093521619
Name:SPENCER, TIFFANY AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:AMANDA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GRAY CT
Mailing Address - Street 2:
Mailing Address - City:HISTORIC NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-6039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 GRAY CT
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-6039
Practice Address - Country:US
Practice Address - Phone:302-319-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health