Provider Demographics
NPI:1144646571
Name:SPERLING, GWEN
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:SPERLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7602
Mailing Address - Country:US
Mailing Address - Phone:505-913-3056
Mailing Address - Fax:505-989-6021
Practice Address - Street 1:440 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7602
Practice Address - Country:US
Practice Address - Phone:505-913-3056
Practice Address - Fax:505-989-6021
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVI-079831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical