Provider Demographics
NPI:1710944798
Name:CHEMRIS, THOMAS W (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:CHEMRIS
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 E SHENENDOAH RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-9029
Mailing Address - Country:US
Mailing Address - Phone:732-256-4033
Mailing Address - Fax:732-938-3085
Practice Address - Street 1:1613 ROUTE 88 W
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3000
Practice Address - Country:US
Practice Address - Phone:732-938-3080
Practice Address - Fax:732-938-3085
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051845001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064977T7DMedicare PIN