Provider Demographics
NPI:1508844283
Name:FLECHA, JOSE A (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:FLECHA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 MAIN ST
Mailing Address - Street 2:GADARA MENTAL HEALTH
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3301
Mailing Address - Country:US
Mailing Address - Phone:413-736-0395
Mailing Address - Fax:
Practice Address - Street 1:2155 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-736-8328
Practice Address - Fax:413-734-1651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10296731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21062Medicare UPIN