Healthcare Provider Details

I. General information

NPI: 1043129448
Provider Name (Legal Business Name): CHICAS CEO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 VALLEY RD UNIT 3771
CLIFTON NJ
07013-1319
US

IV. Provider business mailing address

377 VALLEY RD UNIT 3771
CLIFTON NJ
07013-1319
US

V. Phone/Fax

Practice location:
  • Phone: 929-624-8075
  • Fax:
Mailing address:
  • Phone: 929-624-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: GLORIA PEREZ
Title or Position: DIRECTOR
Credential:
Phone: 929-624-8075