Provider Demographics
NPI:1669728374
Name:CHAFEE, ANGELA (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHAFEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1313
Mailing Address - Country:US
Mailing Address - Phone:860-223-2778
Mailing Address - Fax:860-223-3297
Practice Address - Street 1:26 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1313
Practice Address - Country:US
Practice Address - Phone:860-223-2778
Practice Address - Fax:260-223-3297
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003216103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical