Provider Demographics
NPI:1952464091
Name:CHEVALIER, PAULA MOYNAHAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MOYNAHAN
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VAIL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2162
Mailing Address - Country:US
Mailing Address - Phone:413-782-6694
Mailing Address - Fax:413-782-6694
Practice Address - Street 1:10 CRANE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2360
Practice Address - Country:US
Practice Address - Phone:413-525-2441
Practice Address - Fax:413-567-5270
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1039521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03577Medicare ID - Type UnspecifiedPROVIDER ID