1790081776 NPI number — MRS. JENNIFER ANN CHOKAS LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790081776 NPI number — MRS. JENNIFER ANN CHOKAS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOKAS
Provider First Name:
JENNIFER
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790081776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 530
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUREGAN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-960-0010
Provider Business Mailing Address Fax Number:
860-960-0020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 SOUTH WALNUT ST
Provider Second Line Business Practice Location Address:
530
Provider Business Practice Location Address City Name:
WAUREGAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06387-0530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-960-0010
Provider Business Practice Location Address Fax Number:
860-960-0020
Provider Enumeration Date:
02/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  005973 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8778995401 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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