MR. ANDREW KEODARA PHOMTHAVONG (NPI# 1003110990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003110990 |
| Entity Type | Individual |
| Full Name | MR. ANDREW KEODARA PHOMTHAVONG |
| Credential | MSW |
| Practice Address |
298 Walker Street Lowell MA 01851 |
| Mailing Address |
298 Walker St Lowell MA 01851-1848 |
| Practice Telephone | 6197439052 |
| Mailing Telephone | 6197439052 |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2011-01-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers |
| Street Address |
298 WALKER STREET |
| City | LOWELL |
| State | MA |
| Zip Code | 01851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508340233 | Tara D Gabriel | Social Worker | 130 Pine Street, Lowell, MA 01851 | 2018-09-19 |
| 1699257022 | Jennifer Walsh Favreau | Social Worker | 740 Princeton Blvd. Apt. 22, Lowell, MA 01851 | 2018-09-01 |
| 1366951022 | Natalie V Lopez | Counselor | 507 Redwood Ln, Lowell, MA 01851 | 2017-09-26 |
| 1962929877 | Dependable Transportation Inc. | Non-emergency Medical Transport (VAN) | 45 Pratt Ave, Unit 4, Lowell, MA 01851 | 2017-08-23 |
| 1053851733 | Excel Dental, P.C. | Dentist | 158 Wood Street, Unit 3, Lowell, MA 01851 | 2017-03-01 |
| 1982067468 | Vishal Sohal | Dentist | 26 Wood St, Dental Dreams, Lowell, MA 01851 | 2016-04-01 |
| 1689067407 | Craig David Milliken | Social Worker | 319 Wilder Street, Lowell, MA 01851 | 2015-03-18 |
| 1063801413 | Michael Bobola | Counselor | 22 Old Canal Drrive, Lowell, MA 01851 | 2015-01-22 |
| 1124422944 | Greater Lowell Private Nursing Services and Education | Home Health | 963 Chelmsford Street, Lowell, MA 01851 | 2014-10-22 |
| 1669886602 | Chitrang B. Patel | Dentist | 158 Wood St Unit 3, Lowell, MA 01851 | 2014-06-18 |
| Find all providers in zip 01851 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477867075 | Adam Jacob Martin | Counselor | 2118 Sandpiper Ave, Lowell, AR 72745-8673 | 2010-08-06 |
| 1235301227 | Teresa Raper Collins | Counselor | 2012 Alton Ct, Lowell, NC 28098-2205 | 2008-03-31 |
| 1902096498 | Ryan M Frederick | Counselor | 515 Enterprise Dr 300, Lowell, AR 72745-8982 | 2007-07-31 |
| 1386653723 | Amy Michelle Adams | Counselor | 821 Paradise Pl, Lowell, AR 72745-9312 | 2006-08-05 |
| 1528001955 | Susan Denise Walker | Counselor | 322d N Bloomington St, Lowell, AR 72745-9136 | 2006-06-14 |
| 1902410038 | Giovana Sacchetto Lippi | Counselor | 77 E Merrimack St, Lowell, MA 01852-1251 | 2020-09-04 |
| 1356976286 | Lee Weeks | Counselor | 11630 Fulton St E, Lowell, MI 49331-9426 | 2020-03-11 |
| 1629614862 | Jose A Dominguez | Counselor | 22 Old Canal Dr, Lowell, MA 01851-2730 | 2019-11-22 |
| 1902454143 | Laken Rachelle Colby | Counselor | 11652 W Grand River Ave, Lowell, MI 49331-8465 | 2019-08-30 |
| 1720635469 | Kristin Lothschutz | Counselor | 11650 Downes St Ne, Lowell, MI 49331-9489 | 2019-08-19 |
| Find all providers in LOWELL | ||||
Please comment or provide details below to improve the information on MR. ANDREW KEODARA PHOMTHAVONG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.