Provider Demographics
NPI:1033290150
Name:SPERLING, JACK ALEXANDER (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:ALEXANDER
Last Name:SPERLING
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LEROY STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4603
Mailing Address - Country:US
Mailing Address - Phone:607-722-1918
Mailing Address - Fax:607-724-3865
Practice Address - Street 1:14 LEROY STREET
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4603
Practice Address - Country:US
Practice Address - Phone:607-722-1918
Practice Address - Fax:607-724-3865
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0235911103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11511702OtherCAQH
135362OtherVALUE OPTIONS
135362OtherVALUE OPTIONS