Healthcare Provider Details

I. General information

NPI: 1245082585
Provider Name (Legal Business Name): YERALY AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAIN STREET, SUITE 240A
SPRINGFIELD MA
01115
US

IV. Provider business mailing address

21 RINGGOLD ST
SPRINGFIELD MA
01107-2029
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-7272
  • Fax:
Mailing address:
  • Phone: 413-214-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: