Provider Demographics
NPI:1700123460
Name:CHAVENSON, MARIS (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIS
Middle Name:
Last Name:CHAVENSON
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 1:9 TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2941
Mailing Address - Country:US
Mailing Address - Phone:732-254-4392
Mailing Address - Fax:
Practice Address - Street 1:150 W HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1854
Practice Address - Country:US
Practice Address - Phone:908-725-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05792500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker