Provider Demographics
NPI:1396994067
Name:SPENCE, BARRY W (LCADC)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:W
Last Name:SPENCE
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E FRONT ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1844
Mailing Address - Country:US
Mailing Address - Phone:732-530-4230
Mailing Address - Fax:
Practice Address - Street 1:90 EAST FRONT ST
Practice Address - Street 2:SUITE1
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1844
Practice Address - Country:US
Practice Address - Phone:732-530-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00079600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist