Provider Demographics
NPI:1295899771
Name:SPENCER, STACEY L (EDD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHERRY HILL ROAD
Mailing Address - Street 2:305
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040
Mailing Address - Country:US
Mailing Address - Phone:973-257-9000
Mailing Address - Fax:973-257-0506
Practice Address - Street 1:50 CHERRY HILL ROAD
Practice Address - Street 2:305
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:973-257-9000
Practice Address - Fax:973-257-0506
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00560000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical