Provider Demographics
NPI:1790220804
Name:EMILY CHAPPELL, LCSW-R, P.C.
Entity Type:Organization
Organization Name:EMILY CHAPPELL, LCSW-R, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:631-672-9651
Mailing Address - Street 1:3239 ROUTE 112 STE 5
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1432
Mailing Address - Country:US
Mailing Address - Phone:631-672-9651
Mailing Address - Fax:631-320-1779
Practice Address - Street 1:3239 ROUTE 112 STE 5
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1432
Practice Address - Country:US
Practice Address - Phone:631-672-9651
Practice Address - Fax:631-320-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0640971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03155488Medicaid
NY1447404033Medicare UPIN