Provider Demographics
NPI:1912484510
Name:SPRAGUE, SEAN (BA PSYCH)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:BA PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-2012
Mailing Address - Country:US
Mailing Address - Phone:570-332-5803
Mailing Address - Fax:
Practice Address - Street 1:118 MONAHAN AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1700
Practice Address - Country:US
Practice Address - Phone:570-344-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)