Provider Demographics
NPI:1598883340
Name:CHANG, GISELLE GENEVIEVE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GISELLE
Middle Name:GENEVIEVE
Last Name:CHANG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MT. PLEASANT AVE.
Mailing Address - Street 2:J201
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801
Mailing Address - Country:US
Mailing Address - Phone:973-296-5225
Mailing Address - Fax:
Practice Address - Street 1:120 BETHPAGE TER
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-6982
Practice Address - Country:US
Practice Address - Phone:973-296-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00338100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0098850Medicaid