Provider Demographics
NPI:1073544490
Name:CHESTER, CHRISTINE A (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:CHESTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ARMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4035
Mailing Address - Country:US
Mailing Address - Phone:401-461-0356
Mailing Address - Fax:401-270-4913
Practice Address - Street 1:94 ARMINGTON ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-4035
Practice Address - Country:US
Practice Address - Phone:401-461-0356
Practice Address - Fax:401-270-4913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406747OtherCOORDINATED HEALTH PLANS
RI6258716OtherUBH
RI9373-0OtherBLUE CROSS & BLUE SHIELD
RICC68901Medicaid
RI5640282OtherAETNA
RI809005826OtherMEDICARE PTAN
RICC68901Medicaid
RI9373-0OtherBLUE CROSS & BLUE SHIELD