Provider Demographics
NPI:1629551643
Name:CHESTON, ANN SPROLE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:SPROLE
Last Name:CHESTON
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 1:211 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2338
Mailing Address - Country:US
Mailing Address - Phone:508-380-4143
Mailing Address - Fax:
Practice Address - Street 1:211 NEWTON ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2338
Practice Address - Country:US
Practice Address - Phone:508-380-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool