Healthcare Provider Details

I. General information

NPI: 1558302398
Provider Name (Legal Business Name): PAUL ABBOTT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLEASANT ST
NORTHAMPTON MA
01060-3909
US

IV. Provider business mailing address

129 KING ST
NORTHAMPTON MA
01060-3258
US

V. Phone/Fax

Practice location:
  • Phone: 413-587-7626
  • Fax: 413-585-1376
Mailing address:
  • Phone: 413-587-7626
  • Fax: 413-585-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100254
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: