Healthcare Provider Details

I. General information

NPI: 1689746521
Provider Name (Legal Business Name): ROGER P. CHABOT MSN, LCSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROGER P CHABOT LICSW, LCSW

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 FRED SNOW RD
BECKET MA
01223-9775
US

IV. Provider business mailing address

ROGER CHABOT PO BOX 507
LENOX MA
01240-0507
US

V. Phone/Fax

Practice location:
  • Phone: 413-623-2149
  • Fax:
Mailing address:
  • Phone: 413-623-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113207
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number055702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: