Provider Demographics
NPI:1821659277
Name:CHAE, MARK H (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:CHAE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:H
Other - Last Name:CHAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11 PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4021
Mailing Address - Country:US
Mailing Address - Phone:201-738-4801
Mailing Address - Fax:
Practice Address - Street 1:11 PAWNEE RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4021
Practice Address - Country:US
Practice Address - Phone:201-738-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00312100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional