Provider Demographics
NPI:1871251777
Name:DOUGLAS, NADINE CHANAIR (LMSW)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:CHANAIR
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CATHERINE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-3310
Mailing Address - Country:US
Mailing Address - Phone:475-312-7651
Mailing Address - Fax:
Practice Address - Street 1:127 CATHERINE ST APT 3
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3310
Practice Address - Country:US
Practice Address - Phone:475-312-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5455104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker