Healthcare Provider Details

I. General information

NPI: 1558437079
Provider Name (Legal Business Name): MECHELLE CHESTNUT MA, MT-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E 38TH ST
NEW YORK NY
10016-2604
US

IV. Provider business mailing address

PO BOX 150561
BROOKLYN NY
11215-0561
US

V. Phone/Fax

Practice location:
  • Phone: 646-505-8632
  • Fax:
Mailing address:
  • Phone: 646-505-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: