Provider Demographics
NPI:1316061948
Name:FOGAL, CHELSEA NOELLLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:NOELLLE
Last Name:FOGAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:NOELLE
Other - Last Name:TALLCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:41 1ST ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5728
Mailing Address - Country:US
Mailing Address - Phone:949-750-6678
Mailing Address - Fax:
Practice Address - Street 1:411 LAFAYETTE ST STE 644
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7032
Practice Address - Country:US
Practice Address - Phone:646-450-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker