Provider Demographics
NPI:1457136178
Name:DIMARTINO, SOPHIA MARIE
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S LONGYARD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9335
Mailing Address - Country:US
Mailing Address - Phone:413-478-0330
Mailing Address - Fax:
Practice Address - Street 1:94 N ELM ST STE 206
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1641
Practice Address - Country:US
Practice Address - Phone:413-437-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health