Provider Demographics
NPI:1467168054
Name:SPENCER, JAMALA (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMALA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CATHY CT
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4212
Mailing Address - Country:US
Mailing Address - Phone:845-718-0049
Mailing Address - Fax:
Practice Address - Street 1:13 CATHY CT
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4212
Practice Address - Country:US
Practice Address - Phone:845-718-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2060X
NY1445145201385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child