Provider Demographics
NPI:1912463944
Name:CHIARELLO, CHERYL L (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:CHIARELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 BROAD STREET, PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MILMAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08340-0070
Mailing Address - Country:US
Mailing Address - Phone:609-412-4002
Mailing Address - Fax:
Practice Address - Street 1:LEGACY TREATMENT SERVICES
Practice Address - Street 2:561 TILTON ROAD
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225
Practice Address - Country:US
Practice Address - Phone:609-667-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00621400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional