Provider Demographics
NPI:1306454855
Name:CHUAVIRIYA, ASIA
Entity type:Individual
Prefix:MS
First Name:ASIA
Middle Name:
Last Name:CHUAVIRIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LOCUST CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3544
Mailing Address - Country:US
Mailing Address - Phone:860-595-9652
Mailing Address - Fax:
Practice Address - Street 1:33 PRATT ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1014
Practice Address - Country:US
Practice Address - Phone:860-946-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.004781101YM0800X
106S00000X
CT46.006365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician