Provider Demographics
NPI:1386656890
Name:CHAVKIN, DANA ELLEN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:ELLEN
Last Name:CHAVKIN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1324
Mailing Address - Country:US
Mailing Address - Phone:908-580-0202
Mailing Address - Fax:732-805-9808
Practice Address - Street 1:2 WORLDS FAIR DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1369
Practice Address - Country:US
Practice Address - Phone:908-580-0202
Practice Address - Fax:732-805-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
611520Medicare ID - Type Unspecified