Provider Demographics
NPI:1326126608
Name:DEZENZO, FRANK JOSEPH (LICSW)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JOSEPH
Last Name:DEZENZO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DANIEL SHAYS HWY UNIT 8
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-8920
Mailing Address - Country:US
Mailing Address - Phone:413-687-9988
Mailing Address - Fax:
Practice Address - Street 1:150 FEARING ST STE 13
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002
Practice Address - Country:US
Practice Address - Phone:413-687-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
25011OtherHEALTH NEW ENGLAND
MAPO2855OtherBLUE CROSS BLUE SHIELD
MA7799629OtherCIGNA
MA008378OtherUNICARE STATE PLAN
1092620OtherBEACON HEALTH STRATEGIES