Healthcare Provider Details

I. General information

NPI: 1023224383
Provider Name (Legal Business Name): MWA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

IV. Provider business mailing address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

V. Phone/Fax

Practice location:
  • Phone: 413-598-7777
  • Fax: 413-598-7722
Mailing address:
  • Phone: 413-598-7777
  • Fax: 413-598-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L LOUNSBURY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 413-789-6800