Provider Demographics
NPI:1871636761
Name:CHACE, MONICA (LICSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CHACE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2924
Mailing Address - Country:US
Mailing Address - Phone:401-273-3332
Mailing Address - Fax:
Practice Address - Street 1:100 LAFAYETTE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-722-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICP000204251-001OtherBLUECHIP RI
RI7401-0OtherBLUE CROSS BLUE SHIELD RI