Provider Demographics
NPI:1851656193
Name:MARYANN E. PALEOLOGOPOULOS LICSW, INC
Entity Type:Organization
Organization Name:MARYANN E. PALEOLOGOPOULOS LICSW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PALEOLOGOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-789-0200
Mailing Address - Street 1:2 S BRIDGE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2015
Mailing Address - Country:US
Mailing Address - Phone:413-789-0200
Mailing Address - Fax:413-789-0201
Practice Address - Street 1:2 S BRIDGE DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2015
Practice Address - Country:US
Practice Address - Phone:413-789-0200
Practice Address - Fax:413-789-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty