Healthcare Provider Details

I. General information

NPI: 1144754052
Provider Name (Legal Business Name): JENNIFER CHOKAS, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SOUTH WALNUT ST.
WAUREGAN CT
06387-0530
US

IV. Provider business mailing address

19 SOUTH WALNUT ST. PO BOX 530
WAUREGAN CT
06387-0530
US

V. Phone/Fax

Practice location:
  • Phone: 860-960-0010
  • Fax: 860-960-0020
Mailing address:
  • Phone: 860-960-0010
  • Fax: 860-960-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER ANN CHOKAS
Title or Position: LICENSED CLINICAL SW/BUSINESS OWNER
Credential: LCSW
Phone: 860-771-1166