Provider Demographics
NPI:1073811394
Name:CHESTNUT, MARLENA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARLENA
Middle Name:
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:HARMAN
Mailing Address - State:WV
Mailing Address - Zip Code:26270-0290
Mailing Address - Country:US
Mailing Address - Phone:304-227-4750
Mailing Address - Fax:
Practice Address - Street 1:200 WEESE ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3758
Practice Address - Country:US
Practice Address - Phone:304-637-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WVBP00943655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty