Provider Demographics
NPI:1457011520
Name:DEPEW, CHLOE OLIVIA
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:OLIVIA
Last Name:DEPEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W PACKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2097
Mailing Address - Country:US
Mailing Address - Phone:570-485-5823
Mailing Address - Fax:
Practice Address - Street 1:119 W PACKER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2097
Practice Address - Country:US
Practice Address - Phone:570-485-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114081104100000X
PASW138939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker