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General NPI Number Information
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NPI Number | 1790220804
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Entity Type | Organization
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Legal Business Name | EMILY CHAPPELL, LCSW-R, P.C.
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 3239 ROUTE 112 STE 5
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City | MEDFORD
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State | NY
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Zip | 11763-1432
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Country | US
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Telephone | 631-672-9651
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Fax | 631-320-1779
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Provider Business Mailing Address
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Address Line | 3239 ROUTE 112 STE 5
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City | MEDFORD
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State | NY
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Zip | 11763-1432
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Country | US
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Telephone | 631-672-9651
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Fax | 631-320-1779
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. EMILY F CHAPPELL
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Credential | LCSW-R
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Telephone | 631-672-9651
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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 | 064097
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License Number State | NY
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