Provider Demographics
NPI:1669850483
Name:SPENCE, AMY B
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 BUSTLETON AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1188
Mailing Address - Country:US
Mailing Address - Phone:215-613-6523
Mailing Address - Fax:215-613-6527
Practice Address - Street 1:1001 S BRADFORD ST STE 9
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:215-613-6523
Practice Address - Fax:215-613-6527
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-13-13297103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst