Provider Demographics
NPI:1679748727
Name:SPENCER, TERRANCE JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:JOHN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVENUE
Mailing Address - Street 2:ST MARYS HOSPITAL
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7341
Mailing Address - Fax:518-841-7344
Practice Address - Street 1:427 GUY PARK AVENUE
Practice Address - Street 2:ST MARYS HOSPITAL
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1054
Practice Address - Country:US
Practice Address - Phone:518-841-7341
Practice Address - Fax:518-841-7344
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical