Provider Demographics
NPI:1114328168
Name:SPENCER, PAIGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1120 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-2608
Mailing Address - Country:US
Mailing Address - Phone:850-434-5033
Mailing Address - Fax:
Practice Address - Street 1:1120 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-434-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9135103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical