Provider Demographics
NPI:1407005820
Name:VAN, BAO CHAU
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:CHAU
Last Name:VAN
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 1:264 N MAIN ST
Mailing Address - Street 2:STE 10
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1837
Mailing Address - Country:US
Mailing Address - Phone:413-827-8959
Mailing Address - Fax:
Practice Address - Street 1:264 N MAIN ST
Practice Address - Street 2:STE 10
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1837
Practice Address - Country:US
Practice Address - Phone:413-827-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker