Provider Demographics
NPI:1043470917
Name:VAUGHN, NATHALIE A (MSW)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:A
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HENSHAW AVE STE 2ND
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1234
Mailing Address - Country:US
Mailing Address - Phone:413-561-2230
Mailing Address - Fax:
Practice Address - Street 1:94 KING ST
Practice Address - Street 2:STE 2B
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1202
Practice Address - Country:US
Practice Address - Phone:413-561-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS300562304Medicaid
MA1043470917Medicaid