Provider Demographics
NPI:1619592680
Name:SPRUILL, TENIA
Entity Type:Individual
Prefix:
First Name:TENIA
Middle Name:
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ALEXANDER AVE APT A4
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3062
Mailing Address - Country:US
Mailing Address - Phone:860-801-7279
Mailing Address - Fax:
Practice Address - Street 1:142 ALEXANDER AVE APT A4
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3062
Practice Address - Country:US
Practice Address - Phone:860-801-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician