Provider Demographics
NPI:1316025638
Name:BRAGG, ARLENE DILIDDO (LICSW)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:DILIDDO
Last Name:BRAGG
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 1:8 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1614
Mailing Address - Country:US
Mailing Address - Phone:508-839-7451
Mailing Address - Fax:
Practice Address - Street 1:8 VINCENT RD
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1614
Practice Address - Country:US
Practice Address - Phone:508-839-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical