Provider Demographics
NPI:1013348432
Name:SPENCER, YVONNE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:SPENCER
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 1:54 S 3RD AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3303
Mailing Address - Country:US
Mailing Address - Phone:914-363-6325
Mailing Address - Fax:914-380-4942
Practice Address - Street 1:54 S 3RD AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3303
Practice Address - Country:US
Practice Address - Phone:914-363-6325
Practice Address - Fax:914-380-4942
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20992101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)