Individual
BOUNTHAY PHATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
265 BEACH ST, REVERE, MA 02151-3131
(617) 912-7733
(781) 286-5636
Mailing address
24 CORA ST, WINTHROP, MA 02152-3032
(617) 912-7733
(781) 286-5636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301659
—
MA
Enumeration date
02/01/2007
Last updated
07/08/2007
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