Provider Demographics
NPI:1366508483
Name:SPENCER, RICHARD (RICK) D (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD (RICK)
Middle Name:D
Last Name:SPENCER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6284 RUCKER RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4865
Mailing Address - Country:US
Mailing Address - Phone:317-475-1529
Mailing Address - Fax:317-475-9090
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:SUITE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4865
Practice Address - Country:US
Practice Address - Phone:317-475-1529
Practice Address - Fax:317-475-9090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001835A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical