Provider Demographics
NPI:1144754052
Name:JENNIFER CHOKAS, LCSW, LLC
Entity Type:Organization
Organization Name:JENNIFER CHOKAS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SW/BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-771-1166
Mailing Address - Street 1:19 SOUTH WALNUT ST.
Mailing Address - Street 2:PO BOX 530
Mailing Address - City:WAUREGAN
Mailing Address - State:CT
Mailing Address - Zip Code:06387-0530
Mailing Address - Country:US
Mailing Address - Phone:860-960-0010
Mailing Address - Fax:860-960-0020
Practice Address - Street 1:19 SOUTH WALNUT ST.
Practice Address - Street 2:
Practice Address - City:WAUREGAN
Practice Address - State:CT
Practice Address - Zip Code:06387-0530
Practice Address - Country:US
Practice Address - Phone:860-960-0010
Practice Address - Fax:860-960-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008031277Medicaid
CT1790081776OtherINDIVIDUAL NPI
CT$$$$$$$$$OtherSSN