Provider Demographics
NPI:1023392768
Name:BAGG BATTISTI, SHARON DIANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DIANE
Last Name:BAGG BATTISTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4037
Mailing Address - Country:US
Mailing Address - Phone:607-760-7611
Mailing Address - Fax:607-533-2504
Practice Address - Street 1:11 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4037
Practice Address - Country:US
Practice Address - Phone:607-760-7611
Practice Address - Fax:607-533-2504
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06798101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool