Provider Demographics
NPI:1497154884
Name:SPENCER, BARBARA (BCBA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 HALFMOON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-8707
Mailing Address - Country:US
Mailing Address - Phone:814-571-4225
Mailing Address - Fax:
Practice Address - Street 1:1695 HALFMOON VALLEY RD
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-8707
Practice Address - Country:US
Practice Address - Phone:814-571-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041739OtherBOARD OF APPLIED BEHAVIOR CERTIFICATION