Provider Demographics
NPI:1104988179
Name:NGUYEN, DIEM CHAU LAM (MSW)
Entity type:Individual
Prefix:MS
First Name:DIEM CHAU
Middle Name:LAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2519
Mailing Address - Country:US
Mailing Address - Phone:617-471-2057
Mailing Address - Fax:
Practice Address - Street 1:1353 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2932
Practice Address - Country:US
Practice Address - Phone:617-288-3230
Practice Address - Fax:617-282-0954
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000000024333OtherBMCHP HEALTH PLAN
MAMPP089206OtherLIABILITY INSURANCE
MA0000000024333OtherBMCHP HEALTH PLAN