Provider Demographics
NPI:1922695170
Name:CHILLIS, JANEIDE ALANE
Entity Type:Individual
Prefix:DR
First Name:JANEIDE
Middle Name:ALANE
Last Name:CHILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BALL ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3464
Mailing Address - Country:US
Mailing Address - Phone:973-375-5295
Mailing Address - Fax:
Practice Address - Street 1:123 BALL ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3464
Practice Address - Country:US
Practice Address - Phone:973-930-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging