Provider Demographics
NPI:1285258459
Name:SPRUNG, LAURIE (PHD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SPRUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 QUARTZ KNOB RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1653
Mailing Address - Country:US
Mailing Address - Phone:207-536-7996
Mailing Address - Fax:
Practice Address - Street 1:1 QUARTZ KNOB RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1653
Practice Address - Country:US
Practice Address - Phone:207-536-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6315103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist