Provider Demographics
NPI:1033118567
Name:SPROTZER, EVE JUDITH (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:JUDITH
Last Name:SPROTZER
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHERRY ST
Mailing Address - Street 2:PSYCHOTHERAPY CENTER FOR CHILDREN, ADULTS AND FAMILIES
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3555
Mailing Address - Country:US
Mailing Address - Phone:203-876-0545
Mailing Address - Fax:203-876-0814
Practice Address - Street 1:204 CHERRY ST
Practice Address - Street 2:PSYCHOTHERAPY CENTER FOR CHILDREN, ADULTS AND FAMILIES
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3555
Practice Address - Country:US
Practice Address - Phone:203-876-0545
Practice Address - Fax:203-876-0814
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001868103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680000593Medicare ID - Type Unspecified