Provider Demographics
NPI:1982617783
Name:PAJARILLAGA, SANDRA GONCALVES (LICSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:GONCALVES
Last Name:PAJARILLAGA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1521
Mailing Address - Country:US
Mailing Address - Phone:978-532-2500
Mailing Address - Fax:978-532-0200
Practice Address - Street 1:243 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1521
Practice Address - Country:US
Practice Address - Phone:978-532-2500
Practice Address - Fax:978-532-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22928Medicare ID - Type Unspecified