Provider Demographics
NPI:1073230124
Name:SPARROW THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:SPARROW THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEKA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-259-8078
Mailing Address - Street 1:1515 MARKET ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1932
Mailing Address - Country:US
Mailing Address - Phone:215-259-8078
Mailing Address - Fax:855-564-1867
Practice Address - Street 1:1515 MARKET ST STE 1200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1932
Practice Address - Country:US
Practice Address - Phone:215-259-8078
Practice Address - Fax:855-564-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty