Provider Demographics
NPI:1316413321
Name:SPENCER, BEVERLEE ANN
Entity Type:Individual
Prefix:
First Name:BEVERLEE
Middle Name:ANN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S MUNN AVE APT 1102
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3514
Mailing Address - Country:US
Mailing Address - Phone:347-740-4490
Mailing Address - Fax:
Practice Address - Street 1:60 S MUNN AVE APT 1102
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3514
Practice Address - Country:US
Practice Address - Phone:347-740-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health