Provider Demographics
NPI:1528005972
Name:RESTON, SPENCER ELEANOR (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:SPENCER
Middle Name:ELEANOR
Last Name:RESTON
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:STE 403, PSYCH ASSOCIATES OF MARYLAND LLC
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:STE 403, PSYCH ASSOCIATES OF MARYLAND LLC
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-823-6408
Practice Address - Fax:443-279-0537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD078991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131678OtherCIGN
2131678OtherCIGN GROUP #
53075805OtherBSMD GROUP #
026619OtherVAL
253554OtherCOMP
0017OtherBSDC
331830OtherMHN
398511OtherMAMS
PVPB120034OtherAPS GROUP #
2254027OtherUNHC
252450OtherCOMP GROUP #
53075805OtherBSMD
K452OtherBSDC GROUP #
150NK977OtherMBMD
226289OtherKAIS
PVPB120034OtherAPS
226289OtherKAIS GROUP #
398511OtherMAMS