Individual
PETER G. SPENCER
Active
Individual
PETER G. SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4972
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0522503
MASS HEALTH PROVIDER NO.
MD
01
—
3529-9096
APA MEMBERSHIP NO.
MD
01
—
41071
NAT. REGISTRY NUMBER
MA
01
—
4972
STATE LICENSE NUMBER
MA
05
—
W04700
—
MA
Enumeration date
04/10/2007
Last updated
07/08/2007
Update your record
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