Provider Demographics
NPI:1235239765
Name:TOLLIVER, JOANN F (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:F
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JO-ANN
Other - Middle Name:F
Other - Last Name:DRESSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 N MAIN ST
Mailing Address - Street 2:NORTHAMPTON VAMC
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9764
Mailing Address - Country:US
Mailing Address - Phone:413-584-4040
Mailing Address - Fax:413-582-3137
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:NORTHAMPTON VAMC
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:413-582-3137
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10247161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20251Medicare UPIN