Provider Demographics
NPI:1568893022
Name:CHALAS, JOHELLY
Entity Type:Individual
Prefix:
First Name:JOHELLY
Middle Name:
Last Name:CHALAS
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 1:24 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-1514
Mailing Address - Country:US
Mailing Address - Phone:978-390-0132
Mailing Address - Fax:
Practice Address - Street 1:24 STEINER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-1514
Practice Address - Country:US
Practice Address - Phone:978-390-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA$$$$$$$$$OtherSSN