Provider Demographics
NPI:1205991460
Name:CHESNUTT, KAREN (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHESNUTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 MAIN ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5776
Mailing Address - Country:US
Mailing Address - Phone:716-633-5782
Mailing Address - Fax:716-639-1537
Practice Address - Street 1:5820 MAIN ST
Practice Address - Street 2:SUITE 610
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5776
Practice Address - Country:US
Practice Address - Phone:716-633-5782
Practice Address - Fax:716-639-1537
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008888-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020248802OtherUNIVERA
NY000510201003OtherBLUE CROSSBLUE SHIELD
NY000510201003OtherBLUE CROSSBLUE SHIELD