Provider Demographics
NPI:1043335805
Name:CHASE, CYNTHIA MAY (LCSW, MS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MAY
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ABBEY PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1715
Mailing Address - Country:US
Mailing Address - Phone:860-395-0284
Mailing Address - Fax:914-410-3472
Practice Address - Street 1:1 ABBEY PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1715
Practice Address - Country:US
Practice Address - Phone:860-395-0284
Practice Address - Fax:914-410-3472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0008421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004195170Medicaid
CT140000842CT03OtherANTHEM
CO4195170OtherCT MEDICAL ASSISTANCE PRO
CT004195170Medicaid