Provider Demographics
NPI:1427091974
Name:SPENCE, KAREN (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CHESTNUT ST
Mailing Address - Street 2:APT B2
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5950
Mailing Address - Country:US
Mailing Address - Phone:860-882-7362
Mailing Address - Fax:
Practice Address - Street 1:92 VINE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1433
Practice Address - Country:US
Practice Address - Phone:860-223-9291
Practice Address - Fax:860-223-3111
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003751Medicare ID - Type Unspecified