Provider Demographics
NPI:1477071140
Name:CHAUNCEY, MAUREEN REGINA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:REGINA
Last Name:CHAUNCEY
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DAVEY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5118
Mailing Address - Country:US
Mailing Address - Phone:862-202-9131
Mailing Address - Fax:
Practice Address - Street 1:1012 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2807
Practice Address - Country:US
Practice Address - Phone:972-338-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00581600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional