Provider Demographics
NPI:1982657011
Name:SPERRY, FREDERICK WALKER (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:WALKER
Last Name:SPERRY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2804
Mailing Address - Country:US
Mailing Address - Phone:413-586-6259
Mailing Address - Fax:
Practice Address - Street 1:373 PARK ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3304
Practice Address - Country:US
Practice Address - Phone:413-781-3307
Practice Address - Fax:413-827-9134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1074221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical