Provider Demographics
NPI:1871617035
Name:CHIANCOLA, SAMUEL P (LICSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
Last Name:CHIANCOLA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590
Mailing Address - Country:US
Mailing Address - Phone:508-865-6059
Mailing Address - Fax:508-865-6059
Practice Address - Street 1:260 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-473-4674
Practice Address - Fax:508-865-6059
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA01355104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker