Provider Demographics
NPI:1619183431
Name:ECHEVARRIA, JUAN JOSE (LADCI BSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:ECHEVARRIA
Suffix:
Gender:M
Credentials:LADCI BSW
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:JOSE
Other - Last Name:ECHEVARRIA MEOZNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4822
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01101
Mailing Address - Country:US
Mailing Address - Phone:413-374-8584
Mailing Address - Fax:413-493-2783
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:PROVIDENCE HOSPITAL
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-493-2734
Practice Address - Fax:413-493-2783
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor