Provider Demographics
NPI:1114140241
Name:QUENSEN, CHAD EDWARD (MFT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:EDWARD
Last Name:QUENSEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MANSFIELD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1322
Mailing Address - Country:US
Mailing Address - Phone:860-458-6454
Mailing Address - Fax:
Practice Address - Street 1:19 MANSFIELD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1322
Practice Address - Country:US
Practice Address - Phone:860-458-6454
Practice Address - Fax:833-341-5696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist