Provider Demographics
NPI:1760589865
Name:CHIAVETTA, LORRAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:CHIAVETTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RECKLESS PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1703
Mailing Address - Country:US
Mailing Address - Phone:732-888-9180
Mailing Address - Fax:732-530-4145
Practice Address - Street 1:41 RECKLESS PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1703
Practice Address - Country:US
Practice Address - Phone:732-888-9180
Practice Address - Fax:732-530-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00304400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical