Provider Demographics
NPI:1316098007
Name:SPRAGUE, RALPH MACKENZIE (MA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:MACKENZIE
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAKEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6230
Mailing Address - Country:US
Mailing Address - Phone:207-795-4970
Mailing Address - Fax:207-786-7761
Practice Address - Street 1:1 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6230
Practice Address - Country:US
Practice Address - Phone:207-795-4970
Practice Address - Fax:207-786-7761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERC789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health