Healthcare Provider Details

I. General information

NPI: 1881781441
Provider Name (Legal Business Name): VIRGINIA GUPTILL SIGEL MSW/LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 UNION ST SUITE 303C
NEWTON CENTER MA
02459-2244
US

IV. Provider business mailing address

176 COLLINS RD
WABAN MA
02468-2204
US

V. Phone/Fax

Practice location:
  • Phone: 617-699-1288
  • Fax:
Mailing address:
  • Phone: 617-969-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103395
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: