Provider Demographics
NPI:1639160443
Name:NINEBERG, SPENCER BILLINGS (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SPENCER
Middle Name:BILLINGS
Last Name:NINEBERG
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1207
Mailing Address - Country:US
Mailing Address - Phone:617-497-4510
Mailing Address - Fax:
Practice Address - Street 1:307 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1207
Practice Address - Country:US
Practice Address - Phone:617-497-4510
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10022541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02380OtherBLUE CROSS BLUE SHIELD
MA102254OtherPACIFICAN INSURANCE
MANIP23479Medicare ID - Type Unspecified