Provider Demographics
NPI:1396948477
Name:CHETEYAN, DENNIS J (EDD, LCSW)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:CHETEYAN
Suffix:
Gender:M
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2940
Mailing Address - Country:US
Mailing Address - Phone:201-836-2128
Mailing Address - Fax:201-833-4546
Practice Address - Street 1:815 ELM AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2523
Practice Address - Country:US
Practice Address - Phone:201-836-2128
Practice Address - Fax:201-833-4546
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001519001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical