Provider Demographics
NPI:1912493024
Name:DERSHOWITZ, CHANA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHANA
Middle Name:A
Last Name:DERSHOWITZ
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 1:36 KEW GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7102
Mailing Address - Country:US
Mailing Address - Phone:732-942-0886
Mailing Address - Fax:
Practice Address - Street 1:545 E COUNTY LINE RD STE 17A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1487
Practice Address - Country:US
Practice Address - Phone:732-330-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057757001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05775700OtherLICENSED CLINICAL SOCIAL WORKER