Provider Demographics
NPI:1780755769
Name:CHELSO, MARLENE A (APRN)
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:A
Last Name:CHELSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:A
Other - Last Name:CHELSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ RM 307
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:856-541-6137
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001752163WP0808X, 363LP0808X, 364SP0808X
NJ26NJ00845100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT890000270Medicare ID - Type Unspecified