Provider Demographics
NPI:1225095219
Name:CHENELLY, DREW (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:
Last Name:CHENELLY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1237
Mailing Address - Country:US
Mailing Address - Phone:585-589-5076
Mailing Address - Fax:585-682-3197
Practice Address - Street 1:121 N MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1237
Practice Address - Country:US
Practice Address - Phone:585-589-5076
Practice Address - Fax:585-682-3197
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6108418OtherINDEPENDENT HEALTH
NY01039427Medicaid
NY000500800003OtherBC/BS WNY
NY100263FCOtherPREFERRED CARE
NY00020516101OtherUNIVERA
NY6108418OtherINDEPENDENT HEALTH
NYR54760Medicare UPIN