Individual
CHAD THEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LMSW
Contact information
Practice address
85 WHEELER RD, CENTRAL ISLIP, NY 11722-2028
(631) 348-5079
Mailing address
36 VAUTRIN AVE, HOLTSVILLE, NY 11742-1624
(631) 816-6744
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
120976
NY
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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