Provider Demographics
NPI:1457550311
Name:SPENCER NEWBURGH, TRACEY L.S. LOVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY L.S.
Middle Name:LOVETTE
Last Name:SPENCER NEWBURGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 GLENCREST LN
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3514
Mailing Address - Country:US
Mailing Address - Phone:301-675-9578
Mailing Address - Fax:
Practice Address - Street 1:9619 GLENCREST LN
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3514
Practice Address - Country:US
Practice Address - Phone:301-675-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY7219103TC0700X
DCPSY1000257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical