Provider Demographics
NPI:1306198510
Name:SIRACO, GABRIELLE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SIRACO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MARIE
Other - Last Name:BEDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:24 FALES ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1704
Mailing Address - Country:US
Mailing Address - Phone:781-812-3183
Mailing Address - Fax:
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2539
Practice Address - Country:US
Practice Address - Phone:508-422-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1147001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical