Provider Demographics
NPI:1194852004
Name:CHABOT, KELLY GERARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KELLY
Middle Name:GERARD
Last Name:CHABOT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DIVISION ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2188
Mailing Address - Country:US
Mailing Address - Phone:518-587-0876
Mailing Address - Fax:
Practice Address - Street 1:18 DIVISION ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2188
Practice Address - Country:US
Practice Address - Phone:518-587-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034250-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9A69OtherEXCELLUS