Healthcare Provider Details

I. General information

NPI: 1548075427
Provider Name (Legal Business Name): ANIELLE ROSE IWANICKI MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S CHURCH ST
PITTSFIELD MA
01201-6157
US

IV. Provider business mailing address

PO BOX 2432
PITTSFIELD MA
01202-2432
US

V. Phone/Fax

Practice location:
  • Phone: 833-623-9750
  • Fax:
Mailing address:
  • Phone: 833-623-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2130058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: