Provider Demographics
NPI:1396857520
Name:VUONG, MY
Entity Type:Individual
Prefix:MS
First Name:MY
Middle Name:
Last Name:VUONG
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 1:27 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:E BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333
Mailing Address - Country:US
Mailing Address - Phone:508-378-3053
Mailing Address - Fax:
Practice Address - Street 1:37 BELMONT ST
Practice Address - Street 2:SOUTH BAY MENTAL HEALTH CENTER INC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-580-4691
Practice Address - Fax:508-588-5751
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1133071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAVU P23893Medicare ID - Type Unspecified