Provider Demographics
NPI:1669638797
Name:ANTARSH, CHERYL S (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:S
Last Name:ANTARSH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070
Mailing Address - Country:US
Mailing Address - Phone:860-658-6990
Mailing Address - Fax:
Practice Address - Street 1:29 WEST MAIN ST
Practice Address - Street 2:BLDG 2 - SUITE 101
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-392-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003414104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
14003414CT01OtherANTHEM BLUECROSS AND BLUESHIELD