Provider Demographics
NPI:1790134997
Name:SPARROW, JOHNNY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:SPARROW
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 1:70 GRECIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1938
Mailing Address - Country:US
Mailing Address - Phone:585-957-0447
Mailing Address - Fax:
Practice Address - Street 1:70 GRECIAN PKWY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1938
Practice Address - Country:US
Practice Address - Phone:585-957-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical