Provider Demographics
NPI:1750438123
Name:CHASEN, JOAN (CSW)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:CHASEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6825
Mailing Address - Country:US
Mailing Address - Phone:845-639-6908
Mailing Address - Fax:845-639-6909
Practice Address - Street 1:180 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965
Practice Address - Country:US
Practice Address - Phone:845-639-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N53981Medicare UPIN
NYN53981Medicare ID - Type Unspecified