Provider Demographics
NPI:1467497289
Name:SPRUNG, SUSAN ELLEN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELLEN
Last Name:SPRUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FEDERAL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2546
Mailing Address - Country:US
Mailing Address - Phone:413-772-0707
Mailing Address - Fax:413-774-1784
Practice Address - Street 1:55 FEDERAL STREET, SUITE 200
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01376-1830
Practice Address - Country:US
Practice Address - Phone:413-772-0707
Practice Address - Fax:413-772-0865
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1040881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32977OtherHEALTH NEW ENGLAND
MA387166OtherTUFTS
1079120OtherBEACON HEALTH SERVICES
MA110031638Medicaid
MAP05627OtherBLUE CROSS/BLUE SHIELD
MA407200OtherMAGELLAN
MA7691523OtherAETNA
12099338OtherUNITED BEHAVIORAL HEALTH
12099338OtherUNITED BEHAVIORAL HEALTH