Provider Demographics
NPI:1275167959
Name:TAYLOR, CHEYENNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:TAYLOR
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 1:26 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1234
Mailing Address - Country:US
Mailing Address - Phone:203-804-6187
Mailing Address - Fax:
Practice Address - Street 1:911-913 STATE ST
Practice Address - Street 2:SSCS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3926
Practice Address - Country:US
Practice Address - Phone:203-503-3530
Practice Address - Fax:203-503-6243
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid