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NPI Code Detail

MEDICARE: MR. FREDERICK WALKER SPERRY M.S.W., L.I.C.S.W.

MEDICARE: MR. FREDERICK WALKER SPERRY M.S.W., L.I.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker107422MA

General Provider Information

NPI Number : 1982657011
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FREDERICK WALKER SPERRY M.S.W., L.I.C.S.W.
Provider Business Mailing Address
First Line : 56 FORBES AVE
Second Line :
City : NORTHAMPTON
State : MA
Zip : 01060-2804
Country : US
Telephone Number : 413-586-6259
Fax Number :
Provider Business Practice Location Address
First Line : 373 PARK ST
Second Line :
City : WEST SPRINGFIELD
State : MA
Zip : 01089-3304
Country : US
Telephone Number : 413-781-3307
Fax Number : 413-827-9134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 07/08/2007

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