Provider Demographics
NPI:1457120438
Name:REID, CHAE DANIELLE (R-DMT)
Entity Type:Individual
Prefix:
First Name:CHAE
Middle Name:DANIELLE
Last Name:REID
Suffix:
Gender:F
Credentials:R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3322
Mailing Address - Country:US
Mailing Address - Phone:856-305-4679
Mailing Address - Fax:
Practice Address - Street 1:1100 E PARK AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3322
Practice Address - Country:US
Practice Address - Phone:856-305-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2880225600000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist