Provider Demographics
NPI:1326827205
Name:CHAPPELL, SHANTAVIA MICHELLE (MSW, BA, LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHANTAVIA
Middle Name:MICHELLE
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MSW, BA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 GRAND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3873
Mailing Address - Country:US
Mailing Address - Phone:203-752-1212
Mailing Address - Fax:
Practice Address - Street 1:458 GRAND AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3873
Practice Address - Country:US
Practice Address - Phone:203-752-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker