Provider Demographics
NPI:1093933277
Name:DIPIETRO, SANDRA (LICSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FLOWER ST
Mailing Address - Street 2:SPRINGFIELD
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2327
Mailing Address - Country:US
Mailing Address - Phone:413-796-7758
Mailing Address - Fax:413-789-7444
Practice Address - Street 1:540 MEADOW STREET EXT
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2035
Practice Address - Country:US
Practice Address - Phone:413-789-7455
Practice Address - Fax:413-789-7444
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4444444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker