Healthcare Provider Details

I. General information

NPI: 1104830934
Provider Name (Legal Business Name): VAMC NORTHAMPTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MAIN ST
LEEDS MA
01053-9764
US

IV. Provider business mailing address

30 SAINT JACQUES AVE
CHICOPEE MA
01020-4254
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-4040
  • Fax:
Mailing address:
  • Phone: 413-534-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number210917
License Number StateMA

VIII. Authorized Official

Name: MR. ROBERT L CARROLL
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 413-584-4040