Provider Demographics
NPI:1639409055
Name:PIMENTAL, CHASTITY J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHASTITY
Middle Name:J
Last Name:PIMENTAL
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 1:1153 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:860-336-8148
Mailing Address - Fax:
Practice Address - Street 1:476 STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1254
Practice Address - Country:US
Practice Address - Phone:860-336-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical