Healthcare Provider Details

I. General information

NPI: 1912731977
Provider Name (Legal Business Name): HALEY WHITEHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 LIBERTY ST
SPRINGFIELD MA
01104-3779
US

IV. Provider business mailing address

171 VADNAIS ST
CHICOPEE MA
01020-3026
US

V. Phone/Fax

Practice location:
  • Phone: 413-272-1333
  • Fax: 413-858-2618
Mailing address:
  • Phone: 413-388-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: