Provider Demographics
NPI:1295924546
Name:SPERRY, RALPH (PHD,)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:SPERRY
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3719
Mailing Address - Country:US
Mailing Address - Phone:617-413-0241
Mailing Address - Fax:
Practice Address - Street 1:397 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3719
Practice Address - Country:US
Practice Address - Phone:617-413-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3206103G00000X
CT001051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist