Provider Demographics
NPI:1649712902
Name:CHU, MARIEL (LCSW)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FORDHAM CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1109
Mailing Address - Country:US
Mailing Address - Phone:845-495-4761
Mailing Address - Fax:
Practice Address - Street 1:432 NEW SALEM RD
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-4825
Practice Address - Country:US
Practice Address - Phone:518-765-3314
Practice Address - Fax:518-765-5547
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0823151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical