Provider Demographics
NPI:1265670855
Name:SPRUNG, IRENE JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:JOAN
Last Name:SPRUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1453
Mailing Address - Country:US
Mailing Address - Phone:212-342-8594
Mailing Address - Fax:212-342-8660
Practice Address - Street 1:408 SENECA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1453
Practice Address - Country:US
Practice Address - Phone:212-342-8594
Practice Address - Fax:212-342-8660
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038241-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR038241-1OtherLICENSE
NY23769OtherEI PROVIDER