Provider Demographics
NPI:1821370834
Name:NGUYEN, KHANH DUC
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:DUC
Last Name:NGUYEN
Suffix:
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 1:15 LENOX ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2666
Mailing Address - Country:US
Mailing Address - Phone:413-746-2001
Mailing Address - Fax:413-746-2024
Practice Address - Street 1:15 LENOX ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2666
Practice Address - Country:US
Practice Address - Phone:413-746-2001
Practice Address - Fax:413-746-2024
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker