Provider Demographics
NPI:1184059008
Name:CHASE, CHARIS LEASE-TREVATHAN
Entity type:Individual
Prefix:MRS
First Name:CHARIS
Middle Name:LEASE-TREVATHAN
Last Name:CHASE
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 1:31 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1136
Mailing Address - Country:US
Mailing Address - Phone:912-704-7741
Mailing Address - Fax:
Practice Address - Street 1:31 MARTIN LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1136
Practice Address - Country:US
Practice Address - Phone:912-704-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005220104100000X
NJ44SC058220001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker