Provider Demographics
NPI:1679145585
Name:CHODOSH, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:CHODOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:CHODOSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3120
Mailing Address - Country:US
Mailing Address - Phone:215-630-6709
Mailing Address - Fax:
Practice Address - Street 1:1215 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5540
Practice Address - Country:US
Practice Address - Phone:267-519-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0230211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical