Provider Demographics
NPI:1760221212
Name:SPOOR, SANDRA EMMA (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:EMMA
Last Name:SPOOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CAMPBELL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4349
Mailing Address - Country:US
Mailing Address - Phone:360-764-9046
Mailing Address - Fax:
Practice Address - Street 1:145 CAMPBELL ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4349
Practice Address - Country:US
Practice Address - Phone:360-764-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228402104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker