Provider Demographics
NPI:1548446925
Name:CHAWNER, THERESA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:CHAWNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:CROCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:38 PATULA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1816
Mailing Address - Country:US
Mailing Address - Phone:203-508-0644
Mailing Address - Fax:
Practice Address - Street 1:38 PATULA CT
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1816
Practice Address - Country:US
Practice Address - Phone:203-508-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CT0090661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008084862Medicaid