MEDICARE: CARMEN ANTONIA CHROBACK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	073291-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588626048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN ANTONIA CHROBACK LCSW

Provider Business Mailing Address
First Line	:	18 AMPERSAND DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6500
Country	:	US
Telephone Number	:	518-566-0100
Fax Number	:	518-561-1648

Provider Business Practice Location Address
First Line	:	18 AMPERSAND DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6500
Country	:	US
Telephone Number	:	518-566-0100
Fax Number	:	518-561-1648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	03/04/2019

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