Healthcare Provider Details

I. General information

NPI: 1952879355
Provider Name (Legal Business Name): BRIANNA L DEQUATTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ELM ST STE 7
WEST SPRINGFIELD MA
01089-1540
US

IV. Provider business mailing address

1111 ELM ST STE 7
WEST SPRINGFIELD MA
01089-1540
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-0300
  • Fax:
Mailing address:
  • Phone: 413-734-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: