Healthcare Provider Details

I. General information

NPI: 1235450578
Provider Name (Legal Business Name): CARISSA LYNN SINCLAIR MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HIGH ST
GREENFIELD MA
01301-2702
US

IV. Provider business mailing address

14A MILL VILLAGE RD
SOUTH DEERFIELD MA
01373-9788
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-5411
  • Fax: 413-773-8429
Mailing address:
  • Phone: 413-665-1595
  • Fax: 413-773-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number216436
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: