Spencer Jenkins Booth, PSYD, HSPP
NPI 1730495813ActiveIndividual· Psychologist, Clinical· Fort Wayne, IN
Psychologist, Clinical (PSYD, HSPP) in Fort Wayne, Indiana, licensed in IN, with an NPI issued in August 2010. Enrolled in Medicare as practitioner - clinical psychologist.
Overview
| NPI | 1730495813 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PSYD, HSPP |
| Sole proprietor | No |
| NPI issued | Aug 26, 2010 |
| Last updated in NPPES | Oct 1, 2024 |
| Certified by provider | Oct 1, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | 20041340A | IN |
| Psychologist, Intellectual & Developmental Disabilities | 103TM1800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (IN) |
|---|
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