Healthcare Provider Details

I. General information

NPI: 1740331529
Provider Name (Legal Business Name): THOMAS JOSEPH CHALACHAN M.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN ST
DANSVILLE NY
14437-1709
US

IV. Provider business mailing address

1680 FIVE MILE LINE RD
PENFIELD NY
14526-9701
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax:
Mailing address:
  • Phone: 585-385-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: