Provider Demographics
NPI:1316988132
Name:SCHOFFSTALL, SANDRA L (LICSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SCHOFFSTALL
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 1:197 GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-9715
Mailing Address - Country:US
Mailing Address - Phone:413-772-6719
Mailing Address - Fax:
Practice Address - Street 1:50 CHAPMAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2415
Practice Address - Country:US
Practice Address - Phone:860-808-4071
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852825Medicaid
MAPO8217OtherBLUE CROSS BLUE SHIELD
MASCP2056Medicare UPIN
MA1852825Medicaid