Provider Demographics
NPI:1568286912
Name:EKSTROM, CHLOE ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:ROSE
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S BROADWAY APT 2E
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4534
Mailing Address - Country:US
Mailing Address - Phone:201-543-3735
Mailing Address - Fax:
Practice Address - Street 1:224 S BROADWAY APT 2E
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4534
Practice Address - Country:US
Practice Address - Phone:201-543-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0985881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical