=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417415944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES SIEMIANOWSKI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2019
-----------------------------------------------------
Last Update Date | 03/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 BREWSTER RD
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-313-5111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 BREWSTER RD
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-313-5111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 105844
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------