Provider Demographics
NPI:1235594037
Name:CHASE, JANE M (PHD, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:M
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MONELL
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:574 WEST END AVE.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-362-6715
Mailing Address - Fax:
Practice Address - Street 1:574 WEST END AVE
Practice Address - Street 2:APT #1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-362-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013274-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical