Provider Demographics
NPI:1649648445
Name:CHASE, LINDSEY GILLER (PSYD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:GILLER
Last Name:CHASE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DOGWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3400
Mailing Address - Country:US
Mailing Address - Phone:516-218-0180
Mailing Address - Fax:
Practice Address - Street 1:340 DOGWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3400
Practice Address - Country:US
Practice Address - Phone:516-218-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY022212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY1285628552OtherAGENCIES NPI