Provider Demographics
NPI:1497020929
Name:CHODOSH, BEATRICE MIRTA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:MIRTA
Last Name:CHODOSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5323
Mailing Address - Country:US
Mailing Address - Phone:203-362-3912
Mailing Address - Fax:203-362-2463
Practice Address - Street 1:2400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5323
Practice Address - Country:US
Practice Address - Phone:203-362-3912
Practice Address - Fax:203-362-2463
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional