Provider Demographics
NPI:1003103052
Name:GIRVIN, CHASE BRAD (LMHC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:BRAD
Last Name:GIRVIN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4036
Mailing Address - Country:US
Mailing Address - Phone:347-948-6402
Mailing Address - Fax:
Practice Address - Street 1:786 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2304
Practice Address - Country:US
Practice Address - Phone:347-948-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30537101YA0400X
NJ37PC00950300101YM0800X
NY006588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331944Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331952Medicare Oscar/Certification