Provider Demographics
NPI:1104391234
Name:SPENCER, RENEE ANNE (MSW)
Entity Type:Individual
Prefix:PROF
First Name:RENEE
Middle Name:ANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 REED ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4263
Mailing Address - Country:US
Mailing Address - Phone:617-642-4153
Mailing Address - Fax:
Practice Address - Street 1:124 REED ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4263
Practice Address - Country:US
Practice Address - Phone:617-642-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1077611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical