Provider Demographics
NPI:1962397885
Name:SISCO, DANA (MA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SISCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 BOSTON NECK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2305
Mailing Address - Country:US
Mailing Address - Phone:413-221-5844
Mailing Address - Fax:
Practice Address - Street 1:38 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2201
Practice Address - Country:US
Practice Address - Phone:413-224-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor