Provider Demographics
NPI:1417625237
Name:CHACON-MUNOZ, JOCELYN (LMSW)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:CHACON-MUNOZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3217
Mailing Address - Country:US
Mailing Address - Phone:914-291-3724
Mailing Address - Fax:
Practice Address - Street 1:105 WEST ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3217
Practice Address - Country:US
Practice Address - Phone:914-291-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111305-01104100000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No252Y00000XAgenciesEarly Intervention Provider Agency