Provider Demographics
NPI:1003103052
Name:GIRVIN, CHASE (LMHC,LPC,ACS,LCADC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:GIRVIN
Suffix:
Gender:
Credentials:LMHC,LPC,ACS,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2730
Mailing Address - Country:US
Mailing Address - Phone:347-948-6402
Mailing Address - Fax:
Practice Address - Street 1:63 W MAIN ST STE A-5
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2140
Practice Address - Country:US
Practice Address - Phone:848-300-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30537101YA0400X
NY006588101YM0800X
NJ37PC00950300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331944Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331952Medicare Oscar/Certification