Healthcare Provider Details

I. General information

NPI: 1326952979
Provider Name (Legal Business Name): BRIANNA ADELIA DEMARTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 WORCESTER ST
SOUTHBRIDGE MA
01550-1386
US

IV. Provider business mailing address

5 GLOVER ST APT 3
SOUTHBRIDGE MA
01550-2336
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-0292
  • Fax: 508-765-0294
Mailing address:
  • Phone: 774-289-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: