Provider Demographics
NPI:1124380480
Name:SPENCER, ROBERTA NICOLE (MS SLP)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:NICOLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:NICOLE
Other - Last Name:MARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP
Mailing Address - Street 1:23 DEER RUN PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812
Mailing Address - Country:US
Mailing Address - Phone:914-879-2919
Mailing Address - Fax:914-245-5566
Practice Address - Street 1:2725 CROMPOND RD YORKTOWN CSD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-243-8000
Practice Address - Fax:914-245-5566
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTSSLD1155734235Z00000X
NY023223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist