Provider Demographics
NPI:1609014331
Name:CHOCK-HARRIS, URSULA LIN-OI (LCSW)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:LIN-OI
Last Name:CHOCK-HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:URSULA
Other - Middle Name:LIN-OI
Other - Last Name:CHOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14E WIGGINS FARM DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3132
Mailing Address - Country:US
Mailing Address - Phone:203-640-9741
Mailing Address - Fax:
Practice Address - Street 1:14E WIGGINS FARM DR
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3132
Practice Address - Country:US
Practice Address - Phone:203-640-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004791104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker