Provider Demographics
NPI:1245578806
Name:SPENCER, ZACHARY JOSEPH
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JOSEPH
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 DELANO LN.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821
Mailing Address - Country:US
Mailing Address - Phone:407-928-4408
Mailing Address - Fax:
Practice Address - Street 1:5764 DELANO LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7635
Practice Address - Country:US
Practice Address - Phone:407-928-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health