Provider Demographics
NPI:1851936413
Name:BASTIEN-CHILSON, RACHEL MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:BASTIEN-CHILSON
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 1:624 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2413
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:
Practice Address - Street 1:616 MARY STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13491
Practice Address - Country:US
Practice Address - Phone:315-732-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095381104100000X
NY0920661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker