Basic Information
Provider Information
NPI: 1003001496
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOSTRE
FirstName: LUIS
MiddleName:  
NamePrefix:  
NameSuffix: JR.
Credential: MSW, CAGS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 511 E COLUMBUS AVE
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011052506
CountryCode: US
TelephoneNumber: 4138278959
FaxNumber:  
Practice Location
Address1: 511 E COLUMBUS AVE
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011052506
CountryCode: US
TelephoneNumber: 4138278959
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2007
LastUpdateDate: 12/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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