Provider Demographics
NPI:1811711146
Name:CHACE, PATRICK FIACHNA (LADC II)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:FIACHNA
Last Name:CHACE
Suffix:
Gender:M
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7211
Mailing Address - Country:US
Mailing Address - Phone:866-682-9355
Mailing Address - Fax:
Practice Address - Street 1:604 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7211
Practice Address - Country:US
Practice Address - Phone:866-682-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)