Provider Demographics
NPI:1447214473
Name:CHERNES, RICHARD ALAN (CADC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:CHERNES
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BEAR PATH RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1342
Mailing Address - Country:US
Mailing Address - Phone:203-281-6759
Mailing Address - Fax:
Practice Address - Street 1:2435 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3223
Practice Address - Country:US
Practice Address - Phone:203-214-8526
Practice Address - Fax:203-281-6759
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000476101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOO4263836Medicaid
CTCHERIOtherMEDITECH