Provider Demographics
NPI:1568554467
Name:CHACK, ABBY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:BETH
Last Name:CHACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 W 2ND ST
Mailing Address - Street 2:FL 2
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2502
Mailing Address - Country:US
Mailing Address - Phone:516-594-6652
Mailing Address - Fax:
Practice Address - Street 1:156 W 2ND ST
Practice Address - Street 2:FL 2
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2502
Practice Address - Country:US
Practice Address - Phone:516-594-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWR-0381531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOGO62Medicare ID - Type Unspecified