Provider Demographics
NPI:1588698351
Name:CHAMPOUX, AMY RUTH WINTERS (MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH WINTERS
Last Name:CHAMPOUX
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 1:121 COUNTY CIRCLE
Mailing Address - Street 2:UMASS
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003
Mailing Address - Country:US
Mailing Address - Phone:413-545-0333
Mailing Address - Fax:413-545-2699
Practice Address - Street 1:121 COUNTY CIR
Practice Address - Street 2:BERKSHIRE HOUSE 123 A UMASS
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9256
Practice Address - Country:US
Practice Address - Phone:413-545-0333
Practice Address - Fax:413-545-2699
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23756Medicare ID - Type Unspecified