Provider Demographics
NPI:1851053797
Name:SPENCE, ANDREA ANNETTE (LCSW-R, CCM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANNETTE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LCSW-R, CCM
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R, CCM
Mailing Address - Street 1:58 GAYLORD CIR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3306
Mailing Address - Country:US
Mailing Address - Phone:917-698-6245
Mailing Address - Fax:
Practice Address - Street 1:58 GAYLORD CIR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3306
Practice Address - Country:US
Practice Address - Phone:917-698-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist