Provider Demographics
NPI:1639483191
Name:CHELMOW, THEODORE ROBERT (LMHC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:ROBERT
Last Name:CHELMOW
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 MASSACHUSETTS AVENUE
Mailing Address - Street 2:APARTMENT 806
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:508-333-7699
Mailing Address - Fax:
Practice Address - Street 1:382 MASSACHUSETTS AVENUE
Practice Address - Street 2:APARTMENT 806
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:508-333-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health