Healthcare Provider Details

I. General information

NPI: 1770154718
Provider Name (Legal Business Name): CHENAE BACCHUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHENAE SMITH LCSW

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CALHOUN PL
BRIDGEPORT CT
06604-3403
US

IV. Provider business mailing address

78 BANKSIDE ST
BRIDGEPORT CT
06606-2617
US

V. Phone/Fax

Practice location:
  • Phone: 203-335-2554
  • Fax:
Mailing address:
  • Phone: 347-543-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110790-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17193
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: