Provider Demographics
NPI:1598537532
Name:CHABOT, GWEN MARCELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:MARCELLE
Last Name:CHABOT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827-3504
Mailing Address - Country:US
Mailing Address - Phone:978-504-9206
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03827-3504
Practice Address - Country:US
Practice Address - Phone:978-504-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical