Healthcare Provider Details

I. General information

NPI: 1932515848
Provider Name (Legal Business Name): NUANPRANG SNITBHAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 03/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 E DEDHAM ST
BOSTON MA
02118-2315
US

IV. Provider business mailing address

7784 CRESTVIEW LN
NIWOT CO
80504-7319
US

V. Phone/Fax

Practice location:
  • Phone: 610-292-9299
  • Fax:
Mailing address:
  • Phone: 617-997-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: