Provider Demographics
NPI:1568686699
Name:SPENCER, CHARMAINE D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:D
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LENOX RD APT 7S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2258
Mailing Address - Country:US
Mailing Address - Phone:718-287-2542
Mailing Address - Fax:
Practice Address - Street 1:596 PROSPECT PL FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4205
Practice Address - Country:US
Practice Address - Phone:718-362-1450
Practice Address - Fax:718-638-9124
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074503-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074503-1OtherLICENSED SOCIAL WORKER