Provider Demographics
NPI:1619569225
Name:CHADWELL, ALLEY FANESI (LISW, LICDC, LCSW)
Entity type:Individual
Prefix:
First Name:ALLEY
Middle Name:FANESI
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:LISW, LICDC, LCSW
Other - Prefix:
Other - First Name:ALLEY
Other - Middle Name:FANESI
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 FOOTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1501
Mailing Address - Country:US
Mailing Address - Phone:859-630-0350
Mailing Address - Fax:
Practice Address - Street 1:11137 US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-7901
Practice Address - Country:US
Practice Address - Phone:765-647-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161867101YA0400X
IN34009220A1041C0700X
OH18011361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty