Provider Demographics
NPI:1649486457
Name:SARDELLA, ELIZABETH BREEN (MASTERS CADAC II LAD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BREEN
Last Name:SARDELLA
Suffix:
Gender:F
Credentials:MASTERS CADAC II LAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-789-2005
Mailing Address - Fax:
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:PROVIDENCE HOSPITAL
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-539-2853
Practice Address - Fax:413-493-2783
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor