Healthcare Provider Details

I. General information

NPI: 1093933277
Provider Name (Legal Business Name): SANDRA DIPIETRO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MEADOW STREET EXT
AGAWAM MA
01001-2035
US

IV. Provider business mailing address

75 FLOWER ST SPRINGFIELD
SPRINGFIELD MA
01118-2327
US

V. Phone/Fax

Practice location:
  • Phone: 413-789-7455
  • Fax: 413-789-7444
Mailing address:
  • Phone: 413-796-7758
  • Fax: 413-789-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4444444
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: