Provider Demographics
NPI:1669045738
Name:DICOSTANZO, ALLIE M
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:M
Last Name:DICOSTANZO
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 1:72 FARNUM PIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-3224
Mailing Address - Country:US
Mailing Address - Phone:508-500-6168
Mailing Address - Fax:781-666-2711
Practice Address - Street 1:61 LINCOLN ST STE 203
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:781-666-2711
Practice Address - Fax:781-666-2712
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW026141041C0700X
ISW041061041C0700X
MALICSW11411111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical