Provider Demographics
NPI:1518390418
Name:MACHADO, JOHN CARLOS II
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARLOS
Last Name:MACHADO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HIGHLAND ST
Mailing Address - Street 2:APT. B10
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1360
Mailing Address - Country:US
Mailing Address - Phone:860-604-0905
Mailing Address - Fax:
Practice Address - Street 1:246 PARK ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3314
Practice Address - Country:US
Practice Address - Phone:413-726-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health