Provider Demographics
NPI:1134839657
Name:ELLSWORTH, CHELSEA L (STUDENT)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:L
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LEE
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:193 ROYALSTON RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9637
Mailing Address - Country:US
Mailing Address - Phone:978-894-4199
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3275
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool