Provider Demographics
NPI:1851376792
Name:SIROTA, DEBRA JOYCE (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOYCE
Last Name:SIROTA
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:44 WOOD AVE
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-0483
Mailing Address - Country:US
Mailing Address - Phone:508-339-2856
Mailing Address - Fax:508-339-3516
Practice Address - Street 1:44 WOOD AVE
Practice Address - Street 2:STE 2
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-0483
Practice Address - Country:US
Practice Address - Phone:508-339-2856
Practice Address - Fax:508-339-3516
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892151Medicaid
P03216Medicare ID - Type Unspecified