Provider Demographics
NPI:1033386081
Name:SPENCE, CHRISTINE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0408
Mailing Address - Country:US
Mailing Address - Phone:917-443-7295
Mailing Address - Fax:631-229-6942
Practice Address - Street 1:410 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1197
Practice Address - Country:US
Practice Address - Phone:631-229-6942
Practice Address - Fax:631-229-6942
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist