Provider Demographics
NPI:1679741557
Name:SPENCER, ROSALIE S
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:S
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4538
Mailing Address - Country:US
Mailing Address - Phone:718-485-7655
Mailing Address - Fax:718-485-7667
Practice Address - Street 1:486 E 51ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4538
Practice Address - Country:US
Practice Address - Phone:718-485-7655
Practice Address - Fax:718-485-7667
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441994163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)