Provider Demographics
NPI:1194875773
Name:POSPESIL, AJILLA SARA (LICSW)
Entity type:Individual
Prefix:
First Name:AJILLA
Middle Name:SARA
Last Name:POSPESIL
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 1:423 UNION ST
Mailing Address - Street 2:# 20
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-5621
Mailing Address - Country:US
Mailing Address - Phone:603-444-8900
Mailing Address - Fax:603-444-1582
Practice Address - Street 1:423 UNION ST
Practice Address - Street 2:# 20
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-5621
Practice Address - Country:US
Practice Address - Phone:603-444-8900
Practice Address - Fax:603-444-1582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072566Medicaid
VT1017503Medicaid