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Individual
MS. ELYSE AUDREY SIMONE CHASTAIN-STULTZ
Active
Individual
MS. ELYSE AUDREY SIMONE CHASTAIN-STULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
223772
MA
1041C0700X
Clinical Social Worker
000123290
MA
1041C0700X
Clinical Social Worker
Primary
123290
MA
Other
Enumeration date
09/15/2020
Last updated
01/25/2021
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