Provider Demographics
NPI:1669893640
Name:SPRAGUE, JERI (LCSW)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 CENTRAL AVE B
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2137
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:716-363-6851
Practice Address - Street 1:319 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2137
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:716-363-6851
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086376104100000X
NY0837921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker