Provider Demographics
NPI:1871898635
Name:DORMAN, CHELSA R (LCSW)
Entity type:Individual
Prefix:
First Name:CHELSA
Middle Name:R
Last Name:DORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHELSA
Other - Middle Name:R
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4320 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5925
Mailing Address - Country:US
Mailing Address - Phone:907-729-2500
Mailing Address - Fax:907-729-4232
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:SUITE #1500
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-2500
Practice Address - Fax:907-729-4232
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8EJ912Medicare PIN
AK8EM676Medicare PIN
AK8EM673Medicare PIN
AK8EM672Medicare PIN
AK8EM674Medicare PIN
AK8EM675Medicare PIN
AK8EM678Medicare PIN
AK8EM677Medicare PIN