Provider Demographics
NPI:1407310162
Name:CHMIELEWSKI, STACI ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI ANN
Middle Name:
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9642
Mailing Address - Country:US
Mailing Address - Phone:973-980-1129
Mailing Address - Fax:
Practice Address - Street 1:190 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5342
Practice Address - Country:US
Practice Address - Phone:201-261-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053550001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical