MEDICARE: SIERRA PANNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316724214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA PANNELL

Provider Business Mailing Address
First Line	:	30 WARREN ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-3602
Country	:	US
Telephone Number	:	617-254-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 ARLINGTON ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-2124
Country	:	US
Telephone Number	:	617-254-3110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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Directions to “ SIERRA PANNELL ” Practice Location

Language	Start Address	Practice Location

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