Provider Demographics
NPI:1558073742
Name:CHEVALIER, JUDITH CHARLOTTE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CHARLOTTE
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5622
Mailing Address - Country:US
Mailing Address - Phone:732-539-9295
Mailing Address - Fax:
Practice Address - Street 1:521 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-5622
Practice Address - Country:US
Practice Address - Phone:732-539-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ566827101YS0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ566827Medicaid