Provider Demographics
NPI:1609130285
Name:SPENCE, JACQUELINE ELEANOR (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELEANOR
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 LINCOLN PL
Mailing Address - Street 2:4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5760
Mailing Address - Country:US
Mailing Address - Phone:347-406-7589
Mailing Address - Fax:
Practice Address - Street 1:347 LINCOLN PL
Practice Address - Street 2:4C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5760
Practice Address - Country:US
Practice Address - Phone:347-406-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0673771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical