Provider Demographics
NPI:1235981366
Name:CHRYSALIS THERAPY SERVICES
Entity Type:Organization
Organization Name:CHRYSALIS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-213-3278
Mailing Address - Street 1:63 W MAIN ST STE L-10
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2140
Mailing Address - Country:US
Mailing Address - Phone:908-336-4537
Mailing Address - Fax:
Practice Address - Street 1:63 W MAIN ST STE L-10
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2140
Practice Address - Country:US
Practice Address - Phone:908-336-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health