Provider Demographics
NPI:1982302295
Name:NGUYEN, JOHN PHAM (LPC-A)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 IRANISTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5250
Mailing Address - Country:US
Mailing Address - Phone:203-243-1477
Mailing Address - Fax:
Practice Address - Street 1:269 IRANISTAN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5250
Practice Address - Country:US
Practice Address - Phone:203-243-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.006005-ASOC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT46.006005-ASOCOtherDEPARTMENT OF PUBLIC HEALTH