Provider Demographics
NPI:1114545894
Name:NGUYEN, BINH THAI (LICSW)
Entity type:Individual
Prefix:
First Name:BINH
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LONG AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2674
Mailing Address - Country:US
Mailing Address - Phone:860-680-6478
Mailing Address - Fax:
Practice Address - Street 1:175 FEDERAL ST STE 1400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2237
Practice Address - Country:US
Practice Address - Phone:617-336-3246
Practice Address - Fax:857-401-3013
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1270871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical