Provider Demographics
NPI:1861138323
Name:CHAUCA, MOISES JORDAN
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:JORDAN
Last Name:CHAUCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MERRICK ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1937
Mailing Address - Country:US
Mailing Address - Phone:508-797-6100
Mailing Address - Fax:
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1937
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor