Provider Demographics
NPI:1659851632
Name:SHARMA, VIRGINIA ELLEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:SHARMA
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 1:59 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1851
Mailing Address - Country:US
Mailing Address - Phone:413-572-6709
Mailing Address - Fax:
Practice Address - Street 1:59 CHRISTOPHER DRIVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1851
Practice Address - Country:US
Practice Address - Phone:413-572-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical