Provider Demographics
NPI:1366783078
Name:CHASE, LINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:12A VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8059
Mailing Address - Country:US
Mailing Address - Phone:203-677-1975
Mailing Address - Fax:
Practice Address - Street 1:53 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3346
Practice Address - Country:US
Practice Address - Phone:203-410-6194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical