Healthcare Provider Details

I. General information

NPI: 1669076519
Provider Name (Legal Business Name): CHELSEA ALEXANDRA HEPBURN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 HERITAGE RD STE 1H
SOUTHBURY CT
06488-1699
US

IV. Provider business mailing address

89 ANDREW AVE
NAUGATUCK CT
06770-4320
US

V. Phone/Fax

Practice location:
  • Phone: 203-490-8208
  • Fax:
Mailing address:
  • Phone: 475-329-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12211
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: