Provider Demographics
NPI:1154498764
Name:CHIN, JUNE LOUISE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JUNE
Middle Name:LOUISE
Last Name:CHIN
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:PO BOX 3474
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02304-3474
Mailing Address - Country:US
Mailing Address - Phone:508-208-8577
Mailing Address - Fax:508-895-9990
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4436
Practice Address - Country:US
Practice Address - Phone:508-895-9393
Practice Address - Fax:508-895-9990
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10323941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854585Medicaid
MA5627952OtherFIRST HEALTH
MAP08488OtherBLUE CROSS
MA116800OtherVALUE OPTIONS
MA5627952OtherFIRST HEALTH