Provider Demographics
NPI:1801230818
Name:SPRAGUE, CHANDA (SOCIAL WORK INTERN)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:SOCIAL WORK INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WAREHAM LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-1437
Mailing Address - Country:US
Mailing Address - Phone:702-785-7845
Mailing Address - Fax:
Practice Address - Street 1:113 WAREHAM LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-1437
Practice Address - Country:US
Practice Address - Phone:702-785-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN15350164W00000X
NVCNA015971376K00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide