Carol Spencer, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13717 Issued in FL

Practice address

3905 Grissom Pkwy
Cocoa, FL 32926-3669

Phone

(321) 637-1866

Fax

(321) 634-3539

NPI assigned

Sep 29, 2016

Last updated

May 28, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carol Spencer Mongeau Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CJECDA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Good Samaritan Health & Wellness Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Jasper, GA
  • NPI 1407174675
  Medicare reassignment NPD
• Good Samaritan Health & Wellness Center Inc.

  dba Dragon Care

  • Federally Qualified Health Center (FQHC)
  • Jasper, GA
  • NPI 1215828819
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559001600000",
    "number": "1023567195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 SAMARITAN DR",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301431964",
            "telephone_number": "706-253-4673",
            "fax_number": "706-253-4679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 GRISSOM PKWY",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329263669",
            "telephone_number": "321-637-1866",
            "fax_number": "321-634-3539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "CAROL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2019-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "13717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "MONGEAU",
            "middle_name": "SPENCER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Space Coast Discount Diabetic Supplies, Inc. (Space Coast Diabetic Supplies)
• Space Coast Internal Medicine & Geriatric LLC (Space Coast Internal Medicine)
• Specialized Treatment, Education and Prevention Services, Inc.
• Carmen M Spector, PT
• Daylin Spence
• Spirit Laboratory Services
• Srinivas Dontineni MD PA (Brevard Hospitalist Associates)
• Chelsea Stacy
• Samantha Steele, RBT
• Georgiann Grace Steely

• Clinical Social Worker in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.