Provider Demographics
NPI:1861902710
Name:GARSTAD, CHEYENNE RENE (LCSW)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:RENE
Last Name:GARSTAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:RENE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3251
Mailing Address - Country:US
Mailing Address - Phone:603-313-2940
Mailing Address - Fax:
Practice Address - Street 1:20 SPRING ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3251
Practice Address - Country:US
Practice Address - Phone:603-313-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057993001041C0700X
NH30761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid