Provider Demographics
NPI:1487869301
Name:SIGDESTAD, ANN MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:SIGDESTAD
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 1:79 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4623
Mailing Address - Country:US
Mailing Address - Phone:978-256-9958
Mailing Address - Fax:978-256-8230
Practice Address - Street 1:79 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4623
Practice Address - Country:US
Practice Address - Phone:978-256-9958
Practice Address - Fax:978-256-8230
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1036151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA713983OtherTUFTS HEALTH PLAN
MASIPO1410OtherBLUE CROSS BLUE SHIELD
MA713983OtherTUFTS HEALTH PLAN