Basic Information
Provider Information
NPI: 1902124431
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TERMINI
FirstName: CHELSEA
MiddleName: ROSE
NamePrefix:  
NameSuffix:  
Credential: MS.ED, MHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 810 CLASSON AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112386102
CountryCode: US
TelephoneNumber: 7182305100
FaxNumber:  
Practice Location
Address1: 810 CLASSON AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112386102
CountryCode: US
TelephoneNumber: 7182305100
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2010
LastUpdateDate: 05/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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