Provider Demographics
NPI:1578176582
Name:NGUYEN, UYEN TRAN TAN
Entity Type:Individual
Prefix:
First Name:UYEN
Middle Name:TRAN TAN
Last Name:NGUYEN
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 1:61 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1010
Mailing Address - Country:US
Mailing Address - Phone:774-266-8055
Mailing Address - Fax:
Practice Address - Street 1:61 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1010
Practice Address - Country:US
Practice Address - Phone:774-266-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician