Provider Demographics
NPI:1376694059
Name:CHALECKI, DARIEN ANTHONY (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:
First Name:DARIEN
Middle Name:ANTHONY
Last Name:CHALECKI
Suffix:
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-8346
Mailing Address - Fax:860-889-2658
Practice Address - Street 1:331 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-8346
Practice Address - Fax:860-889-2658
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT000450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional