Doctor Name: | ELDA STOREY CHESEBROUGH |
NPI Number: | 1326182353 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LCSW |
License Number: | 005649 |
Business Practice Address: | 107 Wilcox Rd Suite 111 Stonington, CT - 063782614 |
Business Phone Number: | 8605724969 |
Business Fax Number: | 8605725767 |
Mailing Address: | 107 Wilcox Rd, Suite 111 STONINGTON |
State: | CT |
Postal Code: | 063782614 |
Phone Number: | 8605724969 |
Fax Number: | 8605725767 |
NPI Enumeration Date: | 02/15/2007 |
NPI Last Update Date: | 05/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 005649 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |