Healthcare Provider Details

I. General information

NPI: 1124158886
Provider Name (Legal Business Name): LAURIE J CHABOT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 WESTFIELD ST
WEST SPRINGFIELD MA
01089-3891
US

IV. Provider business mailing address

69 SENATOR AVE
AGAWAM MA
01001-2129
US

V. Phone/Fax

Practice location:
  • Phone: 413-206-9585
  • Fax:
Mailing address:
  • Phone: 413-427-3843
  • Fax: 413-827-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7332
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: