Individual
TUAN PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22 PLEASANT ST, MALDEN, MA 02148-5119
(781) 851-2648
Mailing address
11 ESTES ST, LYNN, MA 01902-3057
(857) 222-1710
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100042212066
MASSHEALTH
MA
01
—
N0114518701
TUFTS HEALTH PLAN
MA
Enumeration date
10/01/2017
Last updated
10/01/2017
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