Healthcare Provider Details

I. General information

NPI: 1790081776
Provider Name (Legal Business Name): JENNIFER ANN CHOKAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SOUTH WALNUT ST 530
WAUREGAN CT
06387-0530
US

IV. Provider business mailing address

PO BOX 530
WAUREGAN CT
06387
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 Number005973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: