Provider Demographics
NPI:1275676876
Name:CHOU CHAFFIN, MAISIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAISIE
Middle Name:
Last Name:CHOU CHAFFIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-5033
Mailing Address - Country:US
Mailing Address - Phone:917-375-6158
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8137
Practice Address - Country:US
Practice Address - Phone:917-375-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical