Healthcare Provider Details

I. General information

NPI: 1649688425
Provider Name (Legal Business Name): CHASTITY CHARTIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 USHERS RD STE 8
BALLSTON LAKE NY
12019-1547
US

IV. Provider business mailing address

87 LOUDEN RD
SARATOGA SPRINGS NY
12866-5411
US

V. Phone/Fax

Practice location:
  • Phone: 518-581-7260
  • Fax: 518-633-1218
Mailing address:
  • Phone: 757-630-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: