Provider Demographics
NPI:1851089825
Name:NWACHUKWU, PATRICK IHEANACHO
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:IHEANACHO
Last Name:NWACHUKWU
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 1:94 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2123
Mailing Address - Country:US
Mailing Address - Phone:774-456-2743
Mailing Address - Fax:
Practice Address - Street 1:94 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2123
Practice Address - Country:US
Practice Address - Phone:774-456-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2OI511Q1I101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health