Healthcare Provider Details

I. General information

NPI: 1083383525
Provider Name (Legal Business Name): LYDIA GROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 EXCHANGE ST
CHICOPEE MA
01013-1679
US

IV. Provider business mailing address

PO BOX 791
HOLYOKE MA
01041-0791
US

V. Phone/Fax

Practice location:
  • Phone: 413-594-2141
  • Fax: 413-533-1016
Mailing address:
  • Phone: 413-540-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: