Provider Demographics
NPI:1780930057
Name:CHIU, JEROME T (MA)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:T
Last Name:CHIU
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MAIN ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0342
Mailing Address - Country:US
Mailing Address - Phone:917-628-3217
Mailing Address - Fax:
Practice Address - Street 1:1890 PALMER AVE STE 404
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3031
Practice Address - Country:US
Practice Address - Phone:914-833-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst