Provider Demographics
NPI:1427813831
Name:SPENCER, DEBRA (LMSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FORTUNE RD W APT 2J
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1684
Mailing Address - Country:US
Mailing Address - Phone:845-729-1782
Mailing Address - Fax:
Practice Address - Street 1:480 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4525
Practice Address - Country:US
Practice Address - Phone:845-239-4541
Practice Address - Fax:845-381-1313
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122561-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health