Healthcare Provider Details

I. General information

NPI: 1588562995
Provider Name (Legal Business Name): ANGELICA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2026
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 CHANDLER ST
WORCESTER MA
01609-2924
US

IV. Provider business mailing address

4 EDGEWORTH ST
WORCESTER MA
01605-3260
US

V. Phone/Fax

Practice location:
  • Phone: 774-303-0207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: