=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245609361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSI MUNNING LADC, LCSW, CASAC-M
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2015
-----------------------------------------------------
Last Update Date | 12/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 187 SOUTH CANAAN RD
-----------------------------------------------------
City | CANAAN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-824-1397
-----------------------------------------------------
Fax | 888-848-2908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 187 SOUTH CANAAN RD
-----------------------------------------------------
City | CANAAN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-362-5023
-----------------------------------------------------
Fax | 888-848-2908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------