Provider Demographics
NPI:1093137440
Name:SPRONG, MATTHEW E (PHD, LCPC, CRC, CADC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:SPRONG
Suffix:
Gender:M
Credentials:PHD, LCPC, CRC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1590
Mailing Address - Country:US
Mailing Address - Phone:815-993-8724
Mailing Address - Fax:
Practice Address - Street 1:134 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1590
Practice Address - Country:US
Practice Address - Phone:570-856-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008817101YP2500X
PAPC014797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional