Healthcare Provider Details

I. General information

NPI: 1326142746
Provider Name (Legal Business Name): CALVIN BAXTER CHANDLER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 UNION ST
WESTFIELD MA
01085-2658
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-572-6050
  • Fax: 413-568-1097
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1027812
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: