Healthcare Provider Details

I. General information

NPI: 1811745797
Provider Name (Legal Business Name): MISS HAN THI DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 412
WORCESTER MA
01609-1989
US

IV. Provider business mailing address

500 SALISBURY ST
WORCESTER MA
01609-1265
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-5400
  • Fax:
Mailing address:
  • Phone: 832-877-1677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: