Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003238403 |
---|---|
Provider Name | Ryan Chambers |
First Address | Mansfield, MA 02048-3704 |
Second Address | Attleboro, MA 02703-2570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2014 |
Last Update Date | 20/01/2014 |