Provider Demographics
NPI:1689746521
Name:CHABOT, ROGER P (MSN, LCSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:P
Last Name:CHABOT
Suffix:
Gender:M
Credentials:MSN, LCSW, LICSW
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:P
Other - Last Name:CHABOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, LCSW
Mailing Address - Street 1:ROGER CHABOT
Mailing Address - Street 2:PO BOX 507
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-0507
Mailing Address - Country:US
Mailing Address - Phone:413-623-2149
Mailing Address - Fax:
Practice Address - Street 1:1324 FRED SNOW RD
Practice Address - Street 2:
Practice Address - City:BECKET
Practice Address - State:MA
Practice Address - Zip Code:01223-9775
Practice Address - Country:US
Practice Address - Phone:413-623-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1132071041C0700X
NY0557021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical