Provider Demographics
NPI:1902893910
Name:CHAMPOUX, RICHARD F ((PMH) CNS - BC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:CHAMPOUX
Suffix:
Gender:M
Credentials:(PMH) CNS - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3232
Mailing Address - Street 2:JABISH BROOK CONSULTING
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004
Mailing Address - Country:US
Mailing Address - Phone:413-262-5911
Mailing Address - Fax:815-425-8877
Practice Address - Street 1:151 SOUTH STREET
Practice Address - Street 2:ASR
Practice Address - City:CUMMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01026
Practice Address - Country:US
Practice Address - Phone:800-258-1770
Practice Address - Fax:413-634-5379
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193661364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892681Medicaid
MAPN0760OtherBLUE CROSS/BS
MAPN0760OtherBLUE CROSS/BS
MACS NS 0054Medicare PIN