Healthcare Provider Details

I. General information

NPI: 1033598883
Provider Name (Legal Business Name): BEVERLY ELLEN SPRAGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 NORTH ST
WALPOLE MA
02081-2213
US

IV. Provider business mailing address

503 NORTH ST
WALPOLE MA
02081-2213
US

V. Phone/Fax

Practice location:
  • Phone: 508-801-2392
  • Fax:
Mailing address:
  • Phone: 508-801-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128147
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: