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General NPI Number Information
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NPI Number | 1114545894
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Entity Type | Individual
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Provider Name | BINH THAI NGUYEN LICSW
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Gender | Male
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 175 FEDERAL ST STE 1400
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City | BOSTON
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State | MA
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Zip | 02110-2237
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Country | US
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Telephone | 617-336-3246
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Fax | 857-401-3013
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Provider Business Mailing Address
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Address Line | 23 LONG AVE APT 3
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City | ALLSTON
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State | MA
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Zip | 02134-2674
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Country | US
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Telephone | 860-680-6478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 127087
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License Number State | MA
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