Provider Demographics
NPI:1821355603
Name:CHASE, KIMBERLY (LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 GREENLEIGH AVE UNIT 228
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2025
Mailing Address - Country:US
Mailing Address - Phone:732-535-0227
Mailing Address - Fax:
Practice Address - Street 1:6221 GREENLEIGH AVE UNIT 228
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2025
Practice Address - Country:US
Practice Address - Phone:732-535-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05770400104100000X
GACSW0060901041C0700X
NJ44SC057306001041C0700X
MD232171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker