Provider Demographics
NPI:1013567692
Name:TAYLOR, CHELESA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHELESA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CHELESA
Other - Middle Name:
Other - Last Name:TURNBULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 HARRIMAN DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2410
Practice Address - Country:US
Practice Address - Phone:845-291-2607
Practice Address - Fax:845-360-9058
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107573104100000X
NY095378-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker