Provider Demographics
NPI:1609021666
Name:SPURGEON, KARISSA ANN (LMHC, MED)
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:ANN
Last Name:SPURGEON
Suffix:
Gender:F
Credentials:LMHC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2359
Mailing Address - Country:US
Mailing Address - Phone:860-643-8456
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2044
Practice Address - Country:US
Practice Address - Phone:413-732-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health