Provider Demographics
NPI:1902499130
Name:CHALCO, YOLANDA ADELA (LMSW)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ADELA
Last Name:CHALCO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3207
Mailing Address - Country:US
Mailing Address - Phone:631-334-9497
Mailing Address - Fax:
Practice Address - Street 1:2040 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6536
Practice Address - Country:US
Practice Address - Phone:631-471-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108777104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker