Healthcare Provider Details

I. General information

NPI: 1154248524
Provider Name (Legal Business Name): CHELSEA JENA OHANNESSIAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N MAIN ST
BRISTOL CT
06010-4923
US

IV. Provider business mailing address

420 N MAIN ST
BRISTOL CT
06010-4923
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-5858
  • Fax: 860-585-3839
Mailing address:
  • Phone: 860-583-5858
  • Fax: 860-585-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5885
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: