Provider Demographics
NPI:1275717522
Name:CHAUNCEY, HEATHER ANN
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:CHAUNCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:PLOURDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC, LCAT
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:SHANDAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:12480-0102
Mailing Address - Country:US
Mailing Address - Phone:845-518-3161
Mailing Address - Fax:
Practice Address - Street 1:126 GOLF COURSE ROAD
Practice Address - Street 2:
Practice Address - City:SHANDAKEN
Practice Address - State:NY
Practice Address - Zip Code:12480
Practice Address - Country:US
Practice Address - Phone:845-518-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional