Provider Demographics
NPI:1982880480
Name:SPENCER, BONNIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-0526
Mailing Address - Country:US
Mailing Address - Phone:207-739-2646
Mailing Address - Fax:207-739-1028
Practice Address - Street 1:445 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5987
Practice Address - Country:US
Practice Address - Phone:207-739-2646
Practice Address - Fax:207-739-1028
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC106061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413809299Medicaid