Provider Demographics
NPI:1316659089
Name:ABBOTT, CHANTAL (LCSW)
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STATE ST APT I
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-2851
Mailing Address - Country:US
Mailing Address - Phone:401-308-5128
Mailing Address - Fax:
Practice Address - Street 1:13 STATE ST APT I
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-2851
Practice Address - Country:US
Practice Address - Phone:401-308-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW030091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical