Healthcare Provider Details

I. General information

NPI: 1790437556
Provider Name (Legal Business Name): JOHN MICHAEL CHERNESKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PLAINS RD STE 1E
MILFORD CT
06461-2526
US

IV. Provider business mailing address

102 GREEN MEADOW RD
MILFORD CT
06461-2260
US

V. Phone/Fax

Practice location:
  • Phone: 203-701-6448
  • Fax: 617-807-0958
Mailing address:
  • Phone: 203-701-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5051
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: