Provider Demographics
NPI:1275212003
Name:CHANDLER, MARQUIS (LSW)
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GARABRANT ST UNIT 205
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-4187
Mailing Address - Country:US
Mailing Address - Phone:551-200-8182
Mailing Address - Fax:
Practice Address - Street 1:373 CLERMONT TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8073
Practice Address - Country:US
Practice Address - Phone:551-200-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06906900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker