Provider Demographics
NPI:1225200405
Name:AYE, CHAN MYA
Entity Type:Individual
Prefix:
First Name:CHAN
Middle Name:MYA
Last Name:AYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2666
Mailing Address - Country:US
Mailing Address - Phone:413-746-2001
Mailing Address - Fax:
Practice Address - Street 1:15 LENOX ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2666
Practice Address - Country:US
Practice Address - Phone:413-746-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical