Healthcare Provider Details

I. General information

NPI: 1124274238
Provider Name (Legal Business Name): MRS. JULIA ELIZABETH CHIPKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 03/04/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CARANDO DR
SPRINGFIELD MA
01104-4205
US

IV. Provider business mailing address

33 OHEAR AVE APT 2
ENFIELD CT
06082-3634
US

V. Phone/Fax

Practice location:
  • Phone: 413-865-6919
  • Fax:
Mailing address:
  • Phone: 413-478-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: