Provider Demographics
NPI:1043386444
Name:SPENCER, LAUREL LEA (MSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:LEA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:LEA
Other - Last Name:MOSSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:435 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6001
Mailing Address - Country:US
Mailing Address - Phone:570-322-7873
Mailing Address - Fax:570-322-8026
Practice Address - Street 1:435 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6001
Practice Address - Country:US
Practice Address - Phone:570-322-7873
Practice Address - Fax:570-322-8026
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical