Healthcare Provider Details

I. General information

NPI: 1316025638
Provider Name (Legal Business Name): ARLENE DILIDDO BRAGG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VINCENT RD
NORTH GRAFTON MA
01536-1614
US

IV. Provider business mailing address

8 VINCENT RD
NORTH GRAFTON MA
01536-1614
US

V. Phone/Fax

Practice location:
  • Phone: 508-839-7451
  • Fax:
Mailing address:
  • Phone: 508-839-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105148
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: