Healthcare Provider Details

I. General information

NPI: 1902893910
Provider Name (Legal Business Name): RICHARD F CHAMPOUX (PMH) CNS - BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SOUTH STREET ASR
CUMMINGTON MA
01026
US

IV. Provider business mailing address

PO BOX 3232 JABISH BROOK CONSULTING
AMHERST MA
01004
US

V. Phone/Fax

Practice location:
  • Phone: 800-258-1770
  • Fax: 413-634-5379
Mailing address:
  • Phone: 413-262-5911
  • Fax: 815-425-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number193661
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: