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General NPI Number Information
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NPI Number | 1366848616
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Entity Type | Individual
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Provider Name | MARK CHUOKE LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 207 STORRS RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1638
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Country | US
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Telephone | 860-481-1351
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Fax |
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Provider Business Mailing Address
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Address Line | 265 PAINE RD
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City | POMFRET CENTER
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State | CT
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Zip | 06259-1928
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Country | US
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Telephone | 860-315-7654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002387
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License Number State | CT
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