Provider Demographics
NPI:1639138985
Name:GESUELLE-HART, SANDRA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:GESUELLE-HART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:31 HALL DR
Mailing Address - Street 2:VALLEY MEDICAL GROUP, PC
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-4441
Mailing Address - Fax:413-256-4412
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:VALLEY MEDICAL GROUP, P.C.-AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:866-644-8561
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10245061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07225OtherBLUE CROSS BLUE SHIELD
MA800011935OtherRAILROAD MEDICARE
MA102450OtherTUFTS HEALTH PLAN
MA1295026OtherFALLON
MA28635OtherHEALTH NEW ENGLAND
MA269128000OtherMAGELLAN BEHAVIORAL HEALT
MA2073027OtherCIGNA BEHAVIORAL HEALTH
MA2073027OtherCIGNA BEHAVIORAL HEALTH