Basic Information
| Provider Information | |||||||||
| NPI: | 1043527419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | DARLENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | INTERNSHIP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPENCER | ||||||||
| OtherFirstName: | DARLENE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | INTERNSHIP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 143 FLORIDA DR | ||||||||
| Address2: | |||||||||
| City: | AGAWAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010013565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137890111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 494 APPLETON ST. | ||||||||
| Address2: | COMMUNITY BASED FLEXIBLE SUPPORT | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135321456 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 09/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.