MEDICARE: MS. CARLA PORRETTA SPRAGUE MSW

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
1	1041C0700X	Clinical Social Worker	519773	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0040JN	OTHER		BLUE CROSS BL SHIELD
2	S19773	OTHER	TX	CLINICAL SOC WORKER LIC
3	10008847	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1699844472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA PORRETTA SPRAGUE MSW

Provider Business Mailing Address
First Line	:	5915 COPPERWOOD LANE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248
Country	:	US
Telephone Number	:	972-385-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2995 LBJ FRWY
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75234
Country	:	US
Telephone Number	:	972-620-1889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/22/2026

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Directions to “ MS. CARLA PORRETTA SPRAGUE MSW” Practice Location

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