Healthcare Provider Details

I. General information

NPI: 1073811394
Provider Name (Legal Business Name): MARLENA CHESTNUT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEESE ST
ELKINS WV
26241-3758
US

IV. Provider business mailing address

PO BOX 290
HARMAN WV
26270-0290
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-1002
  • Fax:
Mailing address:
  • Phone: 304-227-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00943655
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: