Provider Demographics
NPI:1568664993
Name:CHIMERA-STASS, GILLIAN RUTH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:RUTH
Last Name:CHIMERA-STASS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:GILLIAN
Other - Middle Name:RUTH
Other - Last Name:CHIMERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1638 8TH AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6375
Mailing Address - Country:US
Mailing Address - Phone:917-620-9400
Mailing Address - Fax:
Practice Address - Street 1:18 SEELEY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1010
Practice Address - Country:US
Practice Address - Phone:917-620-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0435531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical