Provider Demographics
NPI:1134340979
Name:SPROGER, STEVEN ROBERT (LCSW)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:SPROGER
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 1:950 WIGEON WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:83420-5555
Mailing Address - Country:US
Mailing Address - Phone:805-489-2270
Mailing Address - Fax:805-489-2270
Practice Address - Street 1:950 WIGEON WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:83420-5555
Practice Address - Country:US
Practice Address - Phone:805-489-2270
Practice Address - Fax:805-489-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42101041C0700X
ORL28331041C0700X
WALW000072421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP171222 080OtherCCS PROVIDER NUMBER
CACMS171222OtherCHILDREN'S MEDICAL SERVIC