Provider Demographics
NPI:1639239072
Name:SPRUILL, AVON YVETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:AVON
Middle Name:YVETTE
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AVON
Other - Middle Name:YVETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:OFFICE OF CARE MANAGEMENT
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7417
Mailing Address - Fax:203-974-7413
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7417
Practice Address - Fax:203-974-7413
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0031841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800001593Medicare ID - Type UnspecifiedFIRST COAST