Provider Demographics
NPI:1508203233
Name:CHANTREA, VICHEAVY VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:VICHEAVY
Middle Name:VICTORIA
Last Name:CHANTREA
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 1:250 SUFFOLK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-4228
Mailing Address - Country:US
Mailing Address - Phone:978-728-2737
Mailing Address - Fax:
Practice Address - Street 1:250 SUFFOLK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-4228
Practice Address - Country:US
Practice Address - Phone:978-728-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator