Provider Demographics
NPI:1689076044
Name:MAYNARD, CHELSIE (MDIV, LICSW/LCSW)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:MDIV, LICSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2210
Mailing Address - Country:US
Mailing Address - Phone:607-425-0050
Mailing Address - Fax:
Practice Address - Street 1:304 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2263
Practice Address - Country:US
Practice Address - Phone:607-425-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1211931041C0700X
NY0961511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical