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General NPI Number Information
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NPI Number | 1851656193
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Entity Type | Organization
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Legal Business Name | MARYANN E. PALEOLOGOPOULOS LICSW, INC
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 2 S BRIDGE DR SUITE 1B
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City | AGAWAM
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State | MA
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Zip | 01001-2015
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Country | US
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Telephone | 413-789-0200
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Fax | 413-789-0201
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Provider Business Mailing Address
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Address Line | 2 S BRIDGE DR SUITE 1B
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City | AGAWAM
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State | MA
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Zip | 01001-2015
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Country | US
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Telephone | 413-789-0200
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Fax | 413-789-0201
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARYANN E. PALEOLOGOPOULOS
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Credential | LICSW
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Telephone | 413-789-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114945
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License Number State | MA
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