Provider Demographics
NPI:1477675908
Name:PORTER, SPENCER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 LAUREL AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4413
Mailing Address - Country:US
Mailing Address - Phone:301-891-2737
Mailing Address - Fax:301-891-2737
Practice Address - Street 1:6935 LAUREL AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4413
Practice Address - Country:US
Practice Address - Phone:301-891-2737
Practice Address - Fax:301-891-2132
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051721041C0700X
MDU272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217863OtherKAISER
MDB8810001OtherCAREFIRST BCBS
MDPVPB126765OtherAPS HELATHCARE
MD312046OtherMDIPA,OPTIMUM CHOICE, MAM
MD5606101OtherAETNA
MDQS28OtherCAREFIRST BCBS
MDPO654173Medicaid
MDR24711Medicare UPIN
MD217863OtherKAISER