Provider Demographics
NPI:1669076519
Name:HEPBURN, CHELSEA ALEXANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ALEXANDRA
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ANDREW AVE
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4320
Mailing Address - Country:US
Mailing Address - Phone:475-329-1075
Mailing Address - Fax:
Practice Address - Street 1:519 HERITAGE RD STE 1H
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1699
Practice Address - Country:US
Practice Address - Phone:203-490-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical