Provider Demographics
NPI:1043527419
Name:SPENCER, DARLENE (INTERNSHIP)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:INTERNSHIP
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:INTERNSHIP
Mailing Address - Street 1:143 FLORIDA DR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3565
Mailing Address - Country:US
Mailing Address - Phone:413-789-0111
Mailing Address - Fax:
Practice Address - Street 1:494 APPLETON ST.
Practice Address - Street 2:COMMUNITY BASED FLEXIBLE SUPPORT
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-532-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health