Provider Demographics
NPI:1982255105
Name:PIETRONIRO, SALLY M
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:M
Last Name:PIETRONIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:M
Other - Last Name:BORGATTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077
Mailing Address - Country:US
Mailing Address - Phone:413-461-4042
Mailing Address - Fax:413-726-6001
Practice Address - Street 1:800 COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077
Practice Address - Country:US
Practice Address - Phone:413-461-4042
Practice Address - Fax:413-726-6001
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA1281841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program