Provider Demographics
NPI:1821167131
Name:SPENCER, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:MA
Mailing Address - Zip Code:01225-9653
Mailing Address - Country:US
Mailing Address - Phone:413-743-4418
Mailing Address - Fax:413-445-6242
Practice Address - Street 1:251 FENN ST
Practice Address - Street 2:BRIEN CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5269
Practice Address - Country:US
Practice Address - Phone:413-496-9671
Practice Address - Fax:413-445-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor