Provider Demographics
NPI:1083234538
Name:SPARROW, DAVID SR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SPARROW
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MARKET ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1932
Mailing Address - Country:US
Mailing Address - Phone:855-360-2412
Mailing Address - Fax:
Practice Address - Street 1:1515 MARKET ST STE 1200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1932
Practice Address - Country:US
Practice Address - Phone:855-360-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1063700938OtherSOLE PROPRIETOR