Healthcare Provider Details

I. General information

NPI: 1619287125
Provider Name (Legal Business Name): CHELSEA M CHEATHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOYLSTON ST STE 5
BOSTON MA
02116-2774
US

IV. Provider business mailing address

5 ARBROTH ST
DORCHESTER MA
02122-2511
US

V. Phone/Fax

Practice location:
  • Phone: 617-297-8830
  • Fax:
Mailing address:
  • Phone: 617-297-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW03725
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: