Provider Demographics
NPI:1215690888
Name:SPENCER, SHARON (LSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SYNDI
Other - Middle Name:
Other - Last Name:KEALAMAKIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20275 E RITTENHOUSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1661
Mailing Address - Country:US
Mailing Address - Phone:480-987-2053
Mailing Address - Fax:
Practice Address - Street 1:58-130 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9714
Practice Address - Country:US
Practice Address - Phone:808-900-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW2012104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker