Provider Demographics
NPI:1225218613
Name:GINEO, CHANTEL MARIE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:MARIE
Last Name:GINEO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MOUNTAIN BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1836
Mailing Address - Country:US
Mailing Address - Phone:860-637-6559
Mailing Address - Fax:
Practice Address - Street 1:50 ALBANY TPKE
Practice Address - Street 2:SUITE 3010
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2516
Practice Address - Country:US
Practice Address - Phone:860-637-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT002799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional