Provider Demographics
NPI:1821612664
Name:SPENCER, CLEMENT
Entity Type:Individual
Prefix:MR
First Name:CLEMENT
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 1:114 W ELM ST 114 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MO
Mailing Address - Zip Code:64630
Mailing Address - Country:US
Mailing Address - Phone:234-248-3666
Mailing Address - Fax:
Practice Address - Street 1:274 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742
Practice Address - Country:US
Practice Address - Phone:020-747-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool