Provider Demographics
NPI:1912629239
Name:SOCIAL SPARKS, INC
Entity Type:Organization
Organization Name:SOCIAL SPARKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-475-0653
Mailing Address - Street 1:1992 OLD LOUISQUISSET PIKE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4590
Mailing Address - Country:US
Mailing Address - Phone:401-475-0653
Mailing Address - Fax:401-475-0729
Practice Address - Street 1:35 S COUNTY COMMONS WAY BLDG 5D11D8
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-8240
Practice Address - Country:US
Practice Address - Phone:401-475-0653
Practice Address - Fax:401-475-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty