Provider Demographics
NPI:1851468649
Name:CHADROW, MINDY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:ELLEN
Last Name:CHADROW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEETING HOUSE RD
Mailing Address - Street 2:STE.16
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2733
Mailing Address - Country:US
Mailing Address - Phone:978-256-1288
Mailing Address - Fax:978-256-1288
Practice Address - Street 1:1 MEETING HOUSE RD
Practice Address - Street 2:STE.16
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2733
Practice Address - Country:US
Practice Address - Phone:978-256-1288
Practice Address - Fax:978-256-1288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3646103TC0700X
NH769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHH RE4303Medicare ID - Type Unspecified
MAWO3670Medicare ID - Type Unspecified