Provider Demographics
NPI:1316574734
Name:SPENCER, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 DUNMORE RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5131
Mailing Address - Country:US
Mailing Address - Phone:410-258-8921
Mailing Address - Fax:
Practice Address - Street 1:3012 DUNMORE RD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5131
Practice Address - Country:US
Practice Address - Phone:410-258-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist