Healthcare Provider Details

I. General information

NPI: 1326851205
Provider Name (Legal Business Name): JENNIFER E CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MAIN ST
MONROE CT
06468-2872
US

IV. Provider business mailing address

65 HILLTOP DR
SOUTHPORT CT
06890-1206
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-7090
  • Fax:
Mailing address:
  • Phone: 203-243-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14876
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: