Healthcare Provider Details

I. General information

NPI: 1881601474
Provider Name (Legal Business Name): PAUL S. FOSTER-MOORE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
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: 413-789-8048
Mailing address:
  • Phone: 413-598-7777
  • Fax: 413-789-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: