Provider Demographics
NPI:1033598883
Name:SPRAGUE, BEVERLY ELLEN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ELLEN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SAINT ANNS LN
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5719
Mailing Address - Country:US
Mailing Address - Phone:508-801-2392
Mailing Address - Fax:
Practice Address - Street 1:5 SAINT ANNS LN
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5719
Practice Address - Country:US
Practice Address - Phone:508-801-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical