Provider Demographics
NPI:1538759782
Name:ABDALLA, SHARON M
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:ABDALLA
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 1:175 CAREW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2389
Mailing Address - Country:US
Mailing Address - Phone:413-748-6892
Mailing Address - Fax:413-748-6894
Practice Address - Street 1:175 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2389
Practice Address - Country:US
Practice Address - Phone:413-748-6892
Practice Address - Fax:413-748-6894
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker