Provider Demographics
NPI:1790081776
Name:CHOKAS, JENNIFER ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:CHOKAS
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:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:WAUREGAN
Mailing Address - State:CT
Mailing Address - Zip Code:06387
Mailing Address - Country:US
Mailing Address - Phone:860-960-0010
Mailing Address - Fax:860-960-0020
Practice Address - Street 1:19 SOUTH WALNUT ST
Practice Address - Street 2:530
Practice Address - City:WAUREGAN
Practice Address - State:CT
Practice Address - Zip Code:06387-0530
Practice Address - Country:US
Practice Address - Phone:860-960-0010
Practice Address - Fax:860-960-0020
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8778995401Medicaid