Provider Demographics
NPI:1053928895
Name:SPENCER, LILLIAN SERINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:SERINA
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 1:38 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5243
Mailing Address - Country:US
Mailing Address - Phone:845-774-6180
Mailing Address - Fax:
Practice Address - Street 1:38 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-5243
Practice Address - Country:US
Practice Address - Phone:518-406-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1055651041S0200X
NY0939161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool