Provider Demographics
NPI:1659655512
Name:CHESS, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CHESS
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 1:1000 WEST BOSTON POST ROAD
Mailing Address - Street 2:MAMARONECK UNION FREE SCHOOL DISTRICT
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:914-220-3620
Mailing Address - Fax:
Practice Address - Street 1:1000 W BOSTON POST ROAD
Practice Address - Street 2:MAMARONECK UFSD
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-220-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01395326Medicaid