Healthcare Provider Details

I. General information

NPI: 1164675864
Provider Name (Legal Business Name): JEFFREY A CHESTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

V. Phone/Fax

Practice location:
  • Phone: 914-831-2453
  • Fax: 914-347-5544
Mailing address:
  • Phone: 914-831-2453
  • Fax: 914-347-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015092
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP015092
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: