Provider Demographics
NPI:1578731030
Name:SPRINKLE, JAY W (LCSW)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:W
Last Name:SPRINKLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MIDDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4455
Mailing Address - Country:US
Mailing Address - Phone:207-615-5746
Mailing Address - Fax:
Practice Address - Street 1:278 MIDDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4455
Practice Address - Country:US
Practice Address - Phone:207-615-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC97851041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical