Provider Demographics
NPI:1093556524
Name:LANDISMAN, CHLOE SKYE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:SKYE
Last Name:LANDISMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3023
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-3023
Mailing Address - Country:US
Mailing Address - Phone:203-988-6900
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1646
Practice Address - Country:US
Practice Address - Phone:203-988-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT98231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty