Andre Spence, MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

66 Orchard St
Vernon, CT 06066

Phone

(860) 508-9565

NPI assigned

May 3, 2018

Reactivated

Apr 11, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586563200000",
    "number": "1528557709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 FARMINGTON AVE STE 13",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 ORCHARD ST",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "06066",
            "telephone_number": "860-508-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCE",
        "first_name": "ANDRE",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-03",
        "last_updated": "2020-04-11",
        "certification_date": "2020-04-11",
        "deactivation_date": "2020-02-25",
        "reactivation_date": "2020-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Vernon, CT
• Providers in Vernon, CT by specialty
• Mental Health Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.