Provider Demographics
NPI:1205917622
Name:CHOTINER, GAIL RISE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:RISE
Last Name:CHOTINER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SALEM WALK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7132
Mailing Address - Country:US
Mailing Address - Phone:203-877-3011
Mailing Address - Fax:203-877-3541
Practice Address - Street 1:1435 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2702
Practice Address - Country:US
Practice Address - Phone:203-494-6824
Practice Address - Fax:203-877-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0040921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236544Medicaid
CT8000002243Medicare ID - Type Unspecified