Healthcare Provider Details

I. General information

NPI: 1093137440
Provider Name (Legal Business Name): MATTHEW E SPRONG PHD, LCPC, CRC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2014
Last Update Date: 08/01/2025
Certification Date: 02/08/2023
Deactivation Date: 04/15/2025
Reactivation Date: 08/01/2025

III. Provider practice location address

134 BROAD ST STE 2
STROUDSBURG PA
18360-1590
US

IV. Provider business mailing address

134 BROAD ST STE 2
STROUDSBURG PA
18360-1590
US

V. Phone/Fax

Practice location:
  • Phone: 570-856-4232
  • Fax:
Mailing address:
  • Phone: 815-993-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC014797
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: