Provider Demographics
NPI:1639161060
Name:CHESNUT, WALDA C (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:WALDA
Middle Name:C
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 HEMPHILL PLACE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4423
Mailing Address - Country:US
Mailing Address - Phone:518-289-5072
Mailing Address - Fax:518-289-5225
Practice Address - Street 1:2310 NOTT STREET EAST
Practice Address - Street 2:SUITE 3
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-374-6263
Practice Address - Fax:518-289-5225
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY069258-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347562Medicaid