Provider Demographics
NPI:1235648205
Name:WESTON-KELDO, CHARISSE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:WESTON-KELDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2652
Mailing Address - Country:US
Mailing Address - Phone:860-777-6049
Mailing Address - Fax:
Practice Address - Street 1:93 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2652
Practice Address - Country:US
Practice Address - Phone:860-777-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005890OtherLCSW